For the use of referring doctors and optometrists

Best Practice Eyecare Referrals

You can download a proforma referral forms via the buttons below.

We welcome referrals by email (via encrypted Medical Objects*), fax, post, or with the patient when they attend. Referrals via fax or post should be sent to:

Best Practice Eyecare

64 Landsborough Parade, Golden Beach Qld 4551
Fax: (07) 5492 2344
Email: practicemanager@bestpracticeeyecare.com.au

*Medical Objects Pty Ltd – please contact them on email info@medical-objects.com.au, telephone +61 (0) 7 5456 6000, facsimile +61 (0) 7 3221 0220 for more information.

Dr. Michael Karpa Referral

Dr. Michael Karpa Referral

"*" indicates required fields

Referring Practitioner
Practitioner*

Referral Date*
DD slash MM slash YYYY

Prov. No*

Dear Michael,
Could you please see and assess:
Patient
Name*

Referral Date
DD slash MM slash YYYY

Address*

Phone*

Problem
Problem
Examination
Right Eye
VA
R*
u/a

R*
with glasses

Subjective Refraction
IOP
R*

R*
mm Hg

Left Eye
VA
L*
u/a

L*
with glasses

Subjective Refraction
IOP
L*

L*
mm Hg

ANT SEG
ANT SEG
POST SEG
POST SEG
Referral valid for:
3 months
12 months
Other
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Best Practice Eyecare Ophthalmologists

Based on the Sunshine Coast, we provide ophthalmologist, eye care and surgical services of the highest standard. We treat and manage a wide range of eye conditions including cataracts, glaucoma and macular degeneration and more.