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    Refer a patient

    MDFA provides free information, guidance and support to people living with macular disease. For privacy compliance, it's important patients understand that you'll be sharing their personal details.

    Man looking at letters on an eye chart

    This referral form is for registered eye or general health professionals only. If you would like to refer a friend or family member or would like MDFA assistance yourself, please contact MDFA’s National Helpline on 1800 111 709 or via email. We’d love to hear from you.

      Practitioner’s details

      Patient/client details

      Please ask your patient/client to agree to this statement:

      I agree for this practice to provide my personal information (name, contact details, information about my eye health) to Macular Disease Foundation Australia so that MDFA can contact me with information about macular disease and MDFA’s services.

      Please provide at least one contact number*:


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