Patient Referral Form

PleaseĀ download the Patient Referral PDF and submit via fax to 316-609-2177. A Grene Vision Group Call Center representative will call your patient to schedule.

For immediate or urgent needs, please call (316) 636 2010

Patient Referral Form for Ophthalmology

Please complete all sections of form
*Patient name and phone number are required

Patient Referral Form for Ophthalmology

Provider Preferences

4 + 6 =

For immediate or urgent needs, please call (316) 636 2010