Optometrist Referral Form

Complete this form to submit a referral for your patient to Freedom Vision.

Please ensure you inform your patient to expect a call from one of our Freedom Vision by SpaMedica advisors. Patients are welcome to contact us directly on the details outlined below.

+44 (0)330 058 5023

Mon to Fri, 09:00 - 17:30

Optometrist Referral Submission Form

Fields marked with are mandatory.*

Your Details As The Referring Optometrist

Optometrist Full Name*

Optometrist Email*

Your GOC Number*

Practice Name* Practice Postcode* Practice Email*

Your Patient's Details

Patient First Name*

Patient Last Name*

Email*

Primary Phone Number*

Type of treatment the patient is being referred for:*

Your patient will be given the opportunity to have a free 60-minute consultation at one of our hospitals. We will conduct full diagnostics and discuss treatment and lens options during this consultation.

Additional Details:

By submitting this form, your patient gives you consent to pass on their contact details. We will only contact them about this referral enquiry.*

Join our Post-Op Accreditation Programme

01.

Optometrist Benefits

Our programme creates a close partnership between our experienced team and community optometrist, working together to deliver the highest standard of post-operative care. This collaborative approach brings valuable benefits to optometrists:

Confidence your patients will receive rapid, high-quality treatment.
Bespoke Post-Op Partnership Scheme: High post-op fee of £125 per eye.
A dedicated Freedom Vision Surgeon based at your local hospital.
Hassle-free referral pathway with no barriers and an optom helpline for convenience.
Nationwide hospitals ensure we're always close to you and your patients.

02.

Patient Benefits

You can be assured that your patients will receive the best care possible, with a Dedicated Freedom Vision Team Member guiding them through the process from start to finish.

A free, no-obligation consultation to understand their options clearly.
Access to the latest advanced lens solutions including the revolutionary RayOne Galaxy. View Lens Choices
Affordable treatment with flexible 0% payment plans.*
Benefit from quick access to appointments and treatment.
Personalised care with a treatment plan tailored to their lifestyle and vision needs.
In the unlikely event of any concerns after surgery, we have dedicated optometrists available 24/7 to reassure on the recovery process.

03.

Refer with Trust. Reward with Care

Identify a patient looking for a wider choice of lenses.
Refer them by completing our online referral submission form.
Accredited partners earn £125 per eye for each post-op check.

*Acceptance is subject to status, terms and conditions apply.

Freedom Vision is a Trademark of SpaMedica Ltd who is an Appointed Representative of Chrysalis Finance Limited, which is authorised and regulated by the Financial Conduct Authority. SpaMedica Ltd is a credit broker, not a lender. The provider of a payment scheme which is not offered through or by Chrysalis Finance Limited may not be so authorised and regulated.

Request a callback