For urgent/emergency referrals and patients that need to be seen by a CRA physician within 72 hours, do not fill out this form, instead please call our triage line ASAP at (303) 261-1600 x 1.
Urgent diagnoses include:- Endophthalmitis - Horseshoe/Retinal Tear- Retinal Detachment - Macula on/off- Fluid under Retina
*For urgent matters and patients that need to be seen same day, do not fill out this form, instead call our triage service at 303-261-1600*
(To be filled out by referring provider - please send copy of patient’s insurance card)
Colorado Retina Associates is committed to providing our patients and their families with cost-effective care. We accept most major insurances and will bill your insurance carrier directly. We do ask that you verify your benefits and eligibility with your provider before your initial visit. If your insurance provider requires a co-payment for your office visit, please expect to pay that amount in full on the day of your visit. You are responsible for payment of all services that are not covered by your insurance plan. Any balance not covered is due within 30 days of your scheduled appointment. We accept patients who do not have insurance and are self-pay, with payment plan options available. We offer complimentary financial counselors to assist you with your payment arrangement needs. Each treatment plan is unique, please contact our billing department at 303-261-1592 with questions regarding payment plans or financial counseling.
Please upload a copy of the following required patient files to ensure we get your patient scheduled in a timely manner.
If you prefer to FAX, please fax the required patient files ASAP to: 303-261-1601