Durango: 970.828.2200
Farmington: 505.516.1220

Physician Referral Form

Referrals for eye surgery

Physician Referral Form

Complete and fax this Physician Referral Form  to schedule a patient consultation with a vitreoretinal specialist at one of Southwest Retina's locations in Durango, Farmington, or Cortez. If your referral is urgent please call our office directly after faxing the referral form to expedite the timing of the patient's evaluation.

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After Hours Emergencies: Call 970-828-2200. Follow the prompts to leave a message for the on call physician. Proceed to nearest Emergency Room if you have not received a return call within an hour.