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Referring Patients

Referring Patients: Necessary Patient Information

November 2021

Help your patients start protecting their vision as soon as possible and avoid unnecessary insurance challenges by completing the ForeseeHome Order Form in its entirety.

We have made the Order Form shorter, easier to fill out, and included only the necessary information to enroll patients into the program as quickly as possible. On the Order Form, we ask that you also submit face sheet and a copy of insurance. By receiving all of this information with the referral, we are able to verify the best coverage for your patient and avoid any delays that result from incomplete information.

Order Forms come packaged in the back pocket of the patient brochures or you can request a pad of Order Forms through the Practice Resource Center, as well as order patient brochures, using the “Order Resources” button.

Alternatively, you can easily order ForeseeHome for your patients online through the Eye Care Professional (ECP) Portal. You can learn more about everything the ECP Portal has to offer here.

ForeseeHome Order Form

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