Send Enquiry | Queensland Eye Institute

Personal Information

First Name*

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Details about your condition*

Referral Information

Do you have a current referral from your GP or Optometrist?*

Yes
No

GP, Ophthalmologist or Optometrist Name

Practice Name

Referrer's Phone Number

Which QEI Specialist are you being referred to?

*NOTE* Dr Pane does not accept appointments for patients who are involved in work injuries including WorkCover claims, motor vehicle or pedestrian accidents, assaults, insurance claims or cases in which the police or courts are involved. We would be pleased to recommend other neuro-ophthalmologists who take on such work, please call 3239 5000 for advice.

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Have you been treated at the QEI Clinic before?

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