Optometrist Patient Referral

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  • Beverly Hills 310-651-2300
    450 N. Roxbury Dr., 3rd Floor
    Beverly Hills, CA 90210
  • Santa Monica 310-382-5050
    2222 Santa Monica Blvd., Ste. 107
    Santa Monica, CA 90404

Optometrist Patient Referral

  • Gather Up Assil Eye Institute Patient Reviews
    5.0
    Clean. Very well organized.
    Anthony N.

If you are one of Assil Gaur Eye Institute's esteemed Co-managed Care Partners, please fill out the form below and we will be in touch with you and your patient promptly.

 

Any questions? Please call our OD Partner number at (855) 901-6800 or email us directly at comanagement@assileye.com. Also, please FAX the patient's last exam to (310) 651-2342 to complete your referral.

 

  • Optometrist Name
    *
  • Office Location
    *
  • Referring Doctor's Contact Number
    *
  • Patient Information

    PATIENT INFORMATION

  • Patient Name
    *
  • Patient Date of Birth
    *
  • Patient Phone
  • Best Time to Call
  • Patient Street Address
  • Patient City
  • Patient State
  • Patient Zip Code
  • Procedure Details
  • LASIK Fee Quoted
  • Surgeon(s)
  • Office Location
    *
  • FAX Instructions

    Please FAX the patient's last exam to (310) 651-2342 to complete your referral.

  • Google
    Wonderful people, answered all my questions :)
    Claire E.
  • Google
    Choosing the Assil Gaur
    Institute for your eye care is a decision you will not regret.
    I always experience excellent quality me...
    Sonja H.
  • GatherUp
    Very patient and listen to what I was explaining about my eyes.
    Help me overcome my fears for surgery.
    Michelle T.
  • GatherUp
    Very professional and knowledgeable.
    Robert F.
  • GatherUp
    I am so thankfula nd happy with Dr Adele services and would definitely see her again
    Sarvenaz M.
  • GatherUp
    Very professional.
    Glen F.
  • GatherUp
    Dr Adele has to be the most professional, compassionate, and patient doctor I have ever meet. She takes the time to thoroughly ...
    Patricia S.
  • Google
    Dr. Assil and his team are wonderful and caring. I had a great experience and would recommend to anyone looking for any eye iss...
    Ahoo P.
  • GatherUp
    I think you have great Doctors and incredible staff members. I have been a patient for over 25 years and think everyone I have ...
    Thomas M.
  • GatherUp
    It was a great experience and would recommend to anyone looking for eye care.
    John L.
  • GatherUp
    Dr Adeleh is a wonderful caring doctor. She has patience, compassion and great skills. I will recommend her to all my friends.
    Wilbur M.
  • GatherUp
    If you have any eye issues there is only one place you need to go and that is the Assil Gaur Eye Institute. Dr.Kerry Assil has ...
    Richard A.
2399 Total 1st Party Reviews
4.9 out of 5 Stars

Look Who Trusts Their Eyes to Assil Gaur Eye Institute...

  • Lebron James

    LeBron James

    Los Angeles Lakers

    LeBron James is one of the NBA's greatest of all time. He absolutely depends on his vision to perform at the very highest level. That's why he's an AGEI LASIK surgery patient.

  • Anthony Davis, Assil Eye Institute Patient

    Anthony Davis

    Dallas Mavericks
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    Chris Paul

    San Antonio Spurs
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    Paul George

    Philadelphia 76ers
  • Marlee Matlin, Assil Eye Institute Patient

    Marlee Matlin

    Actress
  • Michelle Williams, Assil Eye Institute Patient

    Michelle Williams

    Actress
  • Dwayne Wade, Assil Eye Institute Patient

    Dwyane Wade

    Miami Heat (retired)
  • LaToya Jackson, Assil Eye Institute Patient

    LaToya Jackson

    Entertainer
  • Lorenzo Lamas, Assil Eye Institute Patient

    Lorenzo Lamas

    Actor
  • Philip Bailey, Assil Eye Institute Patient

    Philip Bailey

    Earth Wind and Fire
  • Gary Sinise, Assil Eye Institute Patient

    Gary Sinise

    Actor
  • Rip Hamilton, Assil Eye Institute Patient

    Rip Hamilton

    Former NBA player
  • John Salley, Assil Eye Institute Patient

    John Salley

    Commentator, former NBA player
  • Blair Underwood, Assil Eye Institute Patient

    Blair Underwood

    Actor
  • Tom Arnold, , Assil Eye Institute Patient
    Tom Arnold
    Comedian/Actor
  • Troy Evans
    Troy Evans
    Actor
  • John Noble, Assil Eye Institute Patient
    John Noble
    Actor
  • Isaac Eddy
    Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush, Assil Eye Institute Patient
    Barbara Rush
    Actress
  • John Emerson
    John Emerson
    US Ambassador to Germany
  • Shane Mosley, Assil Eye Institute Patient
    Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Cuttino Mobley
    Former NBA player
  • Seth Gordon, , Assil Eye Institute Patient
    Seth Gordon
    Director
  • Maurice Evans
    Maurice Evans
    Former NBA player
  • Wang Luoyong
    Wang Luoyong
    Actor
  • Jesse Metcalfe, Assil Eye Institute Patient
    Jesse Metcalfe
    Actor
  • Ananda Lewis, Assil Eye Institute Patient
    Ananda Lewis
    Television Personality
  • Rob Brydon, Assil Eye Institute Patient
    Rob Brydon
    Comedian
  • Clifton Collins Jr., Assil Eye Institute Patient
    Clifton Collins Jr.
    Actor
  • Malinda Williams, Assil Eye Institute Patient
    Malinda Williams
    Actress
  • Adrienne Frantz, Assil Eye Institute Patient
    Adrienne Frantz
    Actress
  • Brad Pitt
    Actor
  • LeBron James
    Los Angeles Lakers
  • Anthony Davis
    Dallas Mavericks
  • Chris Paul
    San Antonio Spurs
  • Courtney Cox
    Actress
  • Paul George
    Philadelphia 76ers
  • Marlee Matlin
    Actress
  • Michelle Williams
    Actress
  • Dwyane Wade
    Miami Heat (retired)
  • Jalen Brunson
    New York Knicks
  • Mychal Thompson
    Commentator, former NBA player
  • LaToya Jackson
    Entertainer
  • Lorenzo Lamas
    Actor
  • Philip Bailey
    Earth Wind and Fire
  • Gary Sinise
    Actor
  • Rip Hamilton
    Former NBA player
  • John Salley
    Commentator, former NBA player
  • Blair Underwood
    Actor
  • Tom Arnold
    Comedian/Actor
  • Troy Evans
    Actor
  • John Noble
    Actor
  • Isaac Eddy
    Actor/Director/Teacher
  • Barbara Rush
    Actress
  • Rudy Garciduenas
    Blue Man Group
  • John Emerson
    US Ambassador to Germany
  • Shane Mosley
    Former professional boxer
  • Cuttino Mobley
    Former NBA player
  • Seth Gordon
    Director
  • Maurice Evans
    Former NBA player
  • Cheri Blauwet
    Physician and Wheelchair Racer
  • Wang Luoyong
    Actor
  • Jesse Metcalfe
    Actor
  • Jeana Wilson
    Actress
  • Courtnee Draper
    Actress
  • Ananda Lewis
    Television Personality
  • Robyn Johnson
    Producer
  • Rob Brydon
    Comedian
  • Cary Schuman
    Actor
  • Roland Buddy Lewis Jr.
    Comedian
  • Clifton Collins Jr.
    Actor
  • Malinda Williams
    Actress
  • Chad Jeffers
    Musician
  • Adrienne Frantz
    Actress
  • Franco Carlotto
    Body Builder
  • Brad Mates
    Musician
  • David Pichette
    Musician
  • Mike Melacon
    Professional Baseball Player
  • Nautica de la Cruz
    Radio Personality
  • Lynn Conkwright
    Body Builder
  • Nely Galan
    Producer
  • Roxanne Galla
    Actress
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