Referral Send Your Referral to Georgia Vision Institute Recommend your patient to Georgia Vision Institute: Referring office name(Required)Referring doctors name(Required)Referring office phone(Required)Referring office faxPatient Name(Required)Patient Date of Birth(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Reason for referralPlease fax all pertinent medical records to: Carrollton: 770-834-2531 Villa Rica: 404-256-2006 Douglasville: 678-838-9474
