References
Case studies
Scientific articles
Price list
Co-management
Contact
Connexion
Inscription
Terms & Conditions
Confidentiality policy
+1 (514) 226-2322
references@experiencecare.ca
Refer a patient
Sign in
Enrollment
Dr
First
Last
Optometrist
Change photo
My profile
Disconnect
New reference
See My References
Add a new practice location
Name of the practice location
Phone number
FAX
Email
Address of the Place of Practice
Select a Province...
AB
BC
PE
MB
NB
YEARS
NUDE
WE
QC
SK
NL
NT
YT
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Select the clinic where the patient was consulted
Select...
Add a clinic
PATIENT'S FIRST NAME
PATIENT NAME
PATIENT EMAIL
PATIENT PHONE NUMBER
REASON FOR THE REFERENCE
Select...
Select...
Complete Dry Eye Assessment
Blepharitis Assessment
Growth Factor Rich Plasma (PRGF)
Review of Chalazion/Orgelet
Select link
DATE OF BIRTH
ADDITIONAL NOTES
Upload relevant documents (optional)
Download
{My File Name}
No files have been uploaded yet...
Add footnote/additional information in here.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.