Refer Patient

For Healthcare Professionals

Please submit the online referral form below or download the form and return to Merrick Avenue Optometry by:
Fax: 516-200-0317
Mail: 30 Merrick Ave, Merrick, NY 11566

Or have your patients bring it with them for the specific issue you are referring to us

Thank you in advance for your kind referral!
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  • If you do not already have AdobeReader® installed on your computer, Click Here to download it now.

  • Download the necessary form(s) and fill in the required information.

  • Fax or email us your completed form(s) or bring them with you to your appointment.

  • Patient Referral Form

  • DOWNLOAD​​​​​​​

Upload Completed Referral Form

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