Thank you for trusting RCTX.

Over 2,000 doctors from around the world refer their patients to Retina Consultants of Texas. We love what we do, and look forward to providing you and your patients with exceptional care and support. Please use the referral form below to get started.

For any eye related emergencies, please call us IMMEDIATELY at 713-524-3434. A physician is on call 24/7, including weekends and holidays.

Patient Referral Form

Name of Patient *

Which location is most convenient for your patient? *

Rendering Physician at RCTX

Patient DOB *

Patient Phone *

Patient Language *

Brief Description of Referral *

Name of Referring Doctor / Practice *

Doctor Phone *

Doctor Fax *

Doctor Email *

Upload Patient Images (if available)

Is this your first referral to Retina Consultants of Texas? *

Yes

Do you need referral materials and/or brochures? *

Yes

Notify me about upcoming CE events at RCTX! *

Yes

Are you interested in registering for the RCTX Image Portal? *

Yes

Please leave this field blank.

Urgent Requests

For urgent requests, please call 713-524-3434

Insurance Plans

We accept all major insurance plans

PDF Referral Forms

If you prefer, you can download a form and fax it over.

PDF Referral Form

Thank you for trusting RCTX.

Patient Referral Form

Our New Brenham Location is Now Open

Our New Brenham Location is Now Open