For Referring Providers – Retina Group of New England

Our physicians make great efforts to accommodate your patients’ ophthalmic needs.

To refer a patient, please contact our office:

(860) 444-1292 -Waterford

(860) 887-6429- Norwich

(203) 458-0245- Guilford

Office hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. An emergency referral system is in place 24 hours a day, 7 days a week. We always try to accommodate emergency referrals.

In addition to our clinic, we are home to one of the largest ophthalmic research centers in Connecticut and Rhode Island. We are currently participating in numerous trials for the treatment of macular degeneration (wet and dry), diabetic macular edema, vein occlusions. For more information or to refer a patient, please contact our central office at (860) 444-1292.

Click here for a copy of our referral packet or fill out our nonurgent referral form below:

For Non-Urgent Physician Referrals ONLY please fill out the form below.
Please call the office in case of an emergency.

Patient Name *

First

Last

Date of Birth *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Insurance *

ID# *

Subscriber

Date of Birth

Secondary Insurance

ID#

Subscriber

Date of Birth

Referring Doctor *

Phone *

Fax

Reason for Visit *

RGNE Provider *

Dr. Chaudhry
Dr. Colina-Biscotto
Dr. Yazdanyar
Next Available Provider/Any Provider

Location of Preference *

Waterford
Norwich
Guilford

Urgency of Appointment

Date Patient Must Be Seen (if applicable)

Upload Supporting Documents

Click or drag a file to this area to upload.

For Non-Urgent Physician Referrals ONLY please fill out the form below. Please call the office in case of an emergency.

For Non-Urgent Physician Referrals ONLY please fill out the form below.
Please call the office in case of an emergency.