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Refer a patient

A six-step referral form for optometrists and GPs sending a patient to Mr Jesse Panthagani. We'll contact the patient within one working day and keep you in the loop.

  • Takes about a minute
  • Stays on your device until you send it
  • No obligation, no charge
Before we start

Thank you for referring

We take optometrist and GP referrals every day. This form takes about a minute, captures everything we need to contact your patient, and keeps you copied in at each stage.

If the situation is urgent or clinically complex, please call the clinic directly on 07300 61 71 71 and we’ll triage straight away.

Patient data is submitted securely. See our privacy policy for details.