Welcome to the online patient portal referral forms!

If this is an urgent eye care concern, please call (612) 643-3525. If this is not urgent, please complete the referral form as complete as possible. This will allow us to communicate with your office to show the progress of your patient.  Click the button to begin the HIPAA compliant referral form.


Patient Referral


And thank you trusting your patient with a Wallerich Eye Care provider!