Referral

Referring Physicians and Clinicians:

If you have patients who require specialized low vision care, we invite you to refer them to Beacon Vision Center. Our expert team, led by Dr. Amy Burcham, is dedicated to providing comprehensive and compassionate vision solutions for individuals with visual impairments.

Please fill out the referral form below with the necessary information. Our team will promptly get in touch with your patient to schedule an appointment. We understand the importance of collaborative care, and we value the trust you place in us to support your patients' visual needs. Thank you for entrusting us with the care of your patients.

Patient Referral

Patient Information

Please briefly describe the reason for the referral and any specific concerns or symptoms related to the patient's vision:

By referring the patient to Beacon Vision Center, I confirm that I have obtained the patient's consent to share their information with Beacon Vision Center for the purpose of this referral and intake process.

Medical Records File Upload

Patient Insurance File Upload

Thank you for referring your patient to Beacon Vision Center. Our team will promptly contact the patient to schedule an appointment and provide them with the exceptional low vision care they deserve.


Please fax this completed form and any medical charts to to (214) 420-5091 or email it to frontdesk@beaconvisioncenter.com

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