Keratoconus Patient Referral Form
For optometrists and ophthalmologists referring patients to Keratoconus Specialists of Maryland
Submit a Referral
Please complete the form below with your patient’s information and any relevant clinical notes. Dr. Benjamin Azman will personally contact your patient to discuss their history and schedule their evaluation. A formal report will be sent back to your office following the appointment.
Fields marked with * are required. Prefer to refer by phone or fax? Call (410) 469-7111 or fax to (410) 561-8055.
Prefer Another Method?
Phone: (410) 469-7111
Fax: (410) 561-8055
Address: 1427 Clarkview Road, Suite 300 B-1, Baltimore, MD 21209
What Happens Next
- We receive your referral and review the patient details.
- Dr. Azman personally calls your patient to discuss their history.
- Your patient comes in for a comprehensive evaluation.
- A formal clinical report is sent back to your office.
Questions about referring a patient? Call us at (410) 469-7111 or visit our Referring Doctors page for more information.