Referring Physicians

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Midwest Eye Institute specializes in tertiary eye care for patients already under the care of other medical providers. Very few of our patients are self-referred as we rely on other medically-trained professionals to contact us for patient care assistance beyond basic eye care needs.

If you are not a medical provider, or are seeking ophthalmic eye care for yourself, please contact your general ophthalmologist, your regular optometrist, or even your primary care provider to discuss your vision issues and concerns. They can refer you to the appropriate Midwest Eye Institute practice/physician should they agree your medical problem warrants the type of specialized care our sub-specialists provide.

If you are a medical professional with a patient who needs the attention of one of our sub-specialists, please know our physicians are available 24 hours a day, 7 days a week for ophthalmic consultations and/or emergency care. You can reach us by phone at 317-817-1000 or toll-free at 1-800-822-4699.

Our fellowship-trained ophthalmologists and their staff will treat your patients with respect, compassion and concern. At Midwest Eye Institute, we use state-of-the-art technologies for diagnosis and treatment. Our doctors' involvement in research projects, our academic connections, and our national affiliations help guarantee patients will have the latest medical and surgical methods available to them.

If you are a medical provider who is referring a new patient to us, please complete the following form and click the “Submit” button at the bottom of the form.

* required field

Doctor Referral Form

This form is to be completed by a referral source only. Midwest Eye Institute does not accept self referral. If this is a SAME DAY referral or an EMERGENCY referral please do not use this online referral form, but call the office directly to make your referral.

Referring Physician Information

Patient Information

**Email is/can be used ONLY to communicate with patient regarding appointment days/times.**

Insurance Information

Reason For Consultation

Notice of Confidentiality: This form is confidential and is intended solely for the person indicated above. If you are not the intended person, you are hereby notified of the confidential nature of this form and that you are not entitled to read, copy or otherwise disseminate any of the information disclosed in this form.

Appointment- Office Use Only