Welcome to the referral portal for Lumen Optometric. Please fill out all the pertinent information. Thank you!

Referral Information


Referral Information
Anti-Bot Measure:
Reason for Referral:
Referring Doctor's Name
Referring Doctor's Phone #
Referring Doctor's Office Name
Patient's Name
Patient's DOB (mm/dd/yyyy)
Patient's Phone #
OD Subjective Rx: DVA 20/
OS Subjective Rx: DVA 20/
OD Habitual Rx: DVA 20/
OS Habitual Rx: DVA 20/
Will you be comanaging?

Are there any pertinent details you would like us to know?  

Are there any specific patient cases you would like for us to send your way?  


Please kindly ask your patient to save our number:

(626) 921-0199 as:
"Lumen Referral Doctor"

And please instruct them that they will be receiving a text and an email
to schedule a complimentary consultation.

*Once we initiate treatment, we will send a post-treatment report and the patient will be sent back to you for ongoing comprehensive care, while we *only* manage the specialty care.