Refer A Friend

At Eyecare of Union Square, we provide the highest quality service to all our patients. In order to refer a patient, please use the form below to share the referral information. Please note that we will reach out to the patient first to confirm the appointment or to provide them with an alternative date. You may also call us to refer a patient. Thank you!

Referring Patient Name:

Referring Patient Phone Number:

Referring Patient Email:

New Patient Name:

New Patient Phone Number:

New Patient Email Address:

​​​​​​​If this is an eye emergency, please call our office: (303) 985-0004. If this is a health emergency, please call 911."