Refer a Patient to Pinnacle Eye

Send a referral (including patient demographics) to our fax number: (425) 365-0600

Alternatively, please fill out the below form and we will reach out to your patient.

*** PLEASE NOTE: WE WILL BEGIN SEEING PATIENTS JANUARY 2026 ***

Referring Provider

Provider Phone #

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Provider Fax #

(###)

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Patient Name

First Name

Last Name

Patient DOB

Patient Phone #

(###)

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Patient Email

Medical Insurance

List patient primary insurance and secondary insurance (if applicable) - We accept all major health insurances

Reason for Referral?

Include a specific doctor (if applicable)

Pinnacle Eye