Schedule a Consultation

Appointment Requests Only (Please allow 1 business day for your request to be processed). For any eye related emergencies, please call us IMMEDIATELY at 800-833-5921 (Houston) or 210-903-1046 (San Antonio). A physician is on call 24/7, including weekends and holidays.

Providers: Please use our patient referral form so we can route requests properly.

First Name *

Last Name *

Are you currently a patient? *

Yes

Retinal condition / reason for appointment *

Have you already seen a general ophthalmologist? *

Yes

Are you currently receiving retinal injections? *

Yes

Which option best describes where you are located?
(Choose whichever location is closest / most convenient for you.) *

Rendering Physician at RCTX

Date of Birth *

Mobile Phone *

What is your preferred method of contact

Mobile Phone

Subject of Inquiry

Preferred Date

Preferred Time of Day

Upload Medical Records (if available)

Comments

How did you hear about us?

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