Refer a Patient to Texas Vision Laser Center

Use the short form below to refer your patient to TVLC. It's the easiest, most efficient way to get your patients seen fast.

Need help? For immediate help - call us us: 469.947.2020 or 972.548.2015

Patient Information

Referring Doctor Information

Do you want an email confirmation?

New Patient FormPatient History Form

A short confirmation email containing a unique entry referral code will be sent. No patient details will be included.

If you wish to receive a short confirmation email containing a unique entry referral code for this referral, enter your email address here.

Attach Documents

If the info is accurate, click the SUBMIT button below to complete this referral.

If you requested a confirmation number for this referral, one will be emailed to you if you selected YES above, and provided your email address. (No patient information will be transmitted back to you.)