Referring Doctors

At Detroit Mercy Eye Institute, we provide the highest quality service to all our patients. In order to refer a patient, please fax over the last completed doctor's note to the office or use the form below to request the appointment. Thank you!

Referring Provider Details


​​​​​​​Patient Contact Information


​​​​​​​Patient Insurance


​​​​​​​Appointment Preferences

Attach Visit Notes