About Us
Our Team
Eye Care Services
Comprehensive Eye Exams
Eye Emergencies
Dry Eye Disease
Blepharitis
Advanced Dry Eye Treatment
ZEST – Deep Eyelid Cleaning
Envision IPL + RF Treatment
Advanced Diagnostic Imaging
Our Eyewear Collections
Contact Lenses
Patient Information
Referrals
Contact
Appointments
Pay Your Bill
(312) 761-9660
(312) 761-9660
Appointments
Pay Your Bill
About Us
Our Team
Eye Care Services
Comprehensive Eye Exams
Eye Emergencies
Dry Eye Disease
Blepharitis
Advanced Dry Eye Treatment
ZEST – Deep Eyelid Cleaning
Envision IPL + RF Treatment
Advanced Diagnostic Imaging
Our Eyewear Collections
Contact Lenses
Patient Information
Shop Eye Care Products
Referrals
Contact
Referrals
Refer a Patient to Eye Care By Design
"
*
" indicates required fields
First Name
*
Last Name
*
Patient DOB
*
Reason for Referral
*
Annual Eye Exam
Dry Eye Consultation
Diabetic Eye Exam
Other
if other, please specify
*
Patient will contact us
Please contact the patient
Contact Preference
Physician Name
*
Practice Name
Phone or Email
*
Additional Notes (optional) • Brief clinical notes / concerns
Send consult notes/results back to referring provider.
Communication Preference
Δ
Book Your Visit
Experience a more thoughtful approach to eye care.
Appointments
(312) 761-9660