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Patient Referral

The Institute of Eye Surgery welcomes referrals from practices across Ireland. Please use the form below to refer a patient for specialist assessment or treatment. Once submitted, our clinical team will review the referral and contact the patient directly to arrange an appointment at our Waterford, Clane, or Athlone clinic, as appropriate.

Patient Information

Patient Referral

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Has the patient previously received care at the Institute of Eye Surgery?
Patient Name
Patient Gender
Patient Date of Birth
Referrer's Name

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