Northwest Animal Eye Specialist

13020 NE 85th Street
Kirkland, WA 98033


Please fill out the web form below if you wish to consult with one of our ophthalmologists or refer a patient to us. Please note that your client will still need to reach out to us if they want to schedule an appointment. Please provide as much detail as possible and send us the patient's medical records and any lab work if you are referring them to us. If your case is an emergency and you need an immediate consultation, it would be best to call our office.

  If you would like a hard copy of our referral form to keep on hand, you may download it here. If you wish to submit this hard copy of our referral form, please include any medical records and lab work and email them to or fax them to Kirkland (425) 827-1422 or Renton (425) 264-0375

Referring Veterinarians Form

Name (required)
First Name (required)
Last Name (required)
Organization Name (required)

E-Mail Address (required) :
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
What is the patient's fist and last name? (required)

What is the patient's signalment? (required)

Do you wish to refer the patient for treatment at NWAES or are you only looking for a consultation with an ophthalmologist? For consultations we will get back to you as soon as possible. It may take up to 2 business days to receive a reply. (required)

Is this a mutual patient or a new case for NWAES? (required)

Please provide more details about the patient and their eye issue. (required)

Verify the reCAPTCHA: