Refer a Patient

Refer a patient to Retinal Consultants Medical Group using the form below. If you have an eye emergency or wish to speak with our team, please call any of the office numbers. We are available 7 days a week, 365 days a year, including weekends and holidays.

Name of Patient *

Patient DOB

Patient Phone

Brief Description of Referral or question for physician *

Name of Referring Doctor / Practice *

Doctor Phone *

Doctor Fax *

Doctor Email *

Preferred Location *

Sacramento — Parkcenter DriveSacramento — Greenback LaneChico, CAElk Grove, CAFairfield, CAFolsom, CAGrass Valley, CAModesto, CARoseville, CAStockton, CAYuba City, CA

Upload Patient Images/Documents (if available)

Is this your first referral to Retinal Consultants Medical Group? *

Yes

No

If this is your first referral, a member of our team will reach out to you.

How many providers are in your practice?

1 - 1011 - 2021 - 3031 - 40more than 40

Preferred Contact Method

EmailMobile Phone

Preferred Time of Day

No PreferenceMorningAfternoon

No thanks. Please do not contact me at this time.

Do you need referral materials and/or brochures? *

Yes

No

Notify me about upcoming CE Events at RCMG! *

Yes

No

Submit FormPlease leave this field blank.