Referral Form

Consultation Requests: Download this request form to fill out and fax to (952) 522-4901 or email to Please include pertinent exam notes with your request form.

Click here to download a map and directions to our office.

Please call Melissa Hannegraf (612) 540-2650 with any questions about the referral process, shared care, or if you need to speak with our provider.

For urgent eye care requests please contact our office directly at (952) 522-4900.