Refer a Patient

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Thank you for trusting Retina Consultants of Charleston.

Thank you for entrusting your patients with our care. We accept new patients every day and urgent referrals are seen the same day. As the communities we serve grow, we are expanding our capacity and services to meet the demand for vitreoretinal care.

We are opening new offices, adding physicians, participating in clinical trials, and acquiring the latest technology to improve access to the best treatment available for your patients.

Need a patient referral form?

To refer a patient, download and fax our referral form or complete the online form below.

We look forward to hearing from you!

asterisk (*) denotes mandatory fields

Patient Name *

Patient Date of Birth

Patient Phone

Patient Address

Brief Description of Referral

Select Preferred Doctor

Virgil Alfaro III, M.D.Eric Jablon, M.D.John Kerrison, M.D.Michael Johnson, M.D.

Name of Referring Doctor/Practice *

Doctor Phone *

Doctor Fax *

Doctor Email *

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

Yes

No

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