Rand Eye

Physician Referral Program

Rand Eye Institute Physician Referral Program (PRP)

Complete this form to join the Physician Referral Program

Fields marked with an asterisk(*) are required.



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Practice Specialties

Soft contact lenses
RGP contact lenses
Keratoconus RGP specialty
LASIK co-management
Cataract co-management
Refractive lens exchange co-management
Conductive Keratoplasty (CK) co-management
DSAEK co-management
Glaucoma co-management



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Are you currently receiving our mailings?

Is the above address new or recently changed?

Are you currently participating in the REI “Physicians Referral Program”?

Would you like your consultation reports expedited via e-mail?

Would you routinely like a video of your patient’s surgery?

Please indicate if you want a DVD of the patient surgery.

Suggestions or recommendations to better fit your needs:

How can we help you grow your practice?


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Rand Eye Institute reserves the right to refuse any application for initial or renewed membership. Rand Eye Institute shall be under no obligation to explain the reason for any refusal to grant or renew membership.

We do not give, share, sell, or transfer any personal information to a third party unless required by law. Please review REI's