Welcome to the online patient portal referral forms! If this is an urgent eye care concern, please call (612) 723-9895 and also complete one of the below forms. This will allow us to communicate with your office to show the progress of your patient. Please complete one of the following forms:

General Medical Eye Care (Medical Eye, Special Testing, Emergency Eye Care) –
Download & Print | Complete Online

Neuro-Optometric Evaluation Consult –
Download & Print | Complete Online

Thank you for choosing Wallerich Eye Care!