Make A Referral

Please use our secure online forms to make a referral for service for our low vision clinic and vision rehabilitation services.  Our service territory in Washington State is King, Snohomish and Skagit counties for all services. We also have a low vision clinic in Kitsap county.

For Physicians

Make a secure Physician Referral online

Download the Physician Referral Form

For General Referrals

Make a secure General Referral online

Download the General Referral Form

Downloaded forms can be faxed to (206) 525-0422.