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Referring Doctors
Please use this page to submit an online referral. VRS staff will contact the patient within 1 business day.
Referring Doctor*
Referral Doctor Contact Number:
Patient Name*
Patient Contact Number*
Time Frame
Clinical Notes
Please indicate if you will be sending any patient information or photography by email.
Please send any supporting information to virginiaretinaspecialists@gmail.com.
Your content has been submitted
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