Appointment - Eye Surgery Associates

Appointments for Ophthalmic Care

During business hours:

Please contact us directly to arrange urgent treatment with an appropriate Ophthalmologist.

After business hours, weekends & public holidays:

Post-operative patients of practices working out of Eye Surgery Associates premises – please contact your surgeon with the emergency number provided to you.
Please contact the Royal Victorian Eye & Ear Hospital at 32 Gisborne Street, East Melbourne on 03 9929 8666 or call 000 in an Emergency.

Patient Name*
First Name Surname (Family Name)
Your Date of Birth*
DD slash MM slash YYYY

If an existing patient, DOB assists in identifying you in our system.
Mobile Number*
Email*
Address
Address Line 1 Address Line 2 Suburb State Post Code Country
Name of Eye Specialist at ESA you wish to see*
Preferred Appointment Location*
- East Melbourne
- Malvern
- Doncaster
- Vermont South
- Wherever the Specialist consults
Please note: Specialists are not available at all sites.
Your referring Doctor/ Optometrist / Specialist Details
Referrer’s Name Referrer’s Address Referrer’s Phone Number Referrer’s Email
Condition
Reason for Appointment*
Please provide information about the reason you’ve been referred to us so that our staff can assist you with your appointment (250 max characters).
Upload Referral Letter:
Drop files here or

Max. file size: 1 GB.
Please upload a referral letter here (where applicable)
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