Refer a Patient

Thank you for considering O.In.C for your patient’s ocular inflammatory care. We accept referrals from ophthalmologists, optometrists, rheumatologists, oncologists, and primary care physicians throughout Arizona. Our goal is to make the referral process as seamless as possible for you and your patient.

Patient Referral Form

Our one-page referral form captures everything we need to evaluate your patient.

Please complete and fax to +1 623-307-7700, or complete the form online.

Hours
Mon–Thu8:00 AM – 5:00 PM Fri8:00 AM – 3:00 PM Sat–SunClosed
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Referring Physician Information

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Patient Information

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Gender
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Address
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Country
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Reason for Referral

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Urgency Level

Three Simple Steps

Step 1

Send the Referral

Fax our referral form to +1 623-307-7700, or submit it through our online portal. Please include relevant clinical history, current medications, and the reason for referral.

Step 2

We Contact Your Patient

Our scheduling team reaches out to your patient within two business days to arrange their consultation at a convenient time.

Step 3

You Receive Our Report

After the consultation, we send a detailed report back to your office with our findings, diagnosis, and recommended treatment plan — typically within 5 business days.

Conditions We Accept for Referral

What to Include in Your Referral

To help us prepare for your patient, please include as much of the following as available:

Patient demographics and contact information
Referring provider name, phone, and fax
Relevant clinical history and current diagnosis (if known)
Current ocular and systemic medications
Recent imaging (OCT, FA) and laboratory results
Specific clinical question or reason for referral

Questions About a Referral?

Call our provider line directly at +1 623-307-7699 or fax to +1 623-307-7700. Our clinical team is available Monday through Thursday, 8:00 AM to 5:00 PM, and Friday until 3:00 PM.