Forms & Info | Referring Providers

Referring Providers

Check-in frequently for information on the upcoming Continuing Education Program coming February 2024!

To receive updates please send your current e-mail to Vannessa Simmons at [email protected] or call 605-718-3937

Clinical Trials Currently Enrolling Patients

Click Here to View Dr. Bergman, Khachikian & Jorgensen Studies

Click Here to View Dr. Abraham Studies

Referring Doctor Forms

Fax Referral Form for OD:

If you are an optometrist and are referring a patient to the Black Hills Regional Eye Institute, please complete this form and fax to the Eye Institute.

Retina Detachment Form:

Diagnostic Testing Form:

If you are a doctor’s office referring a patient for a diagnostic test at the Black Hills Regional Eye Institute,
please use this form.

Cataract Post-op Form:

If you are a doctor’s office caring for a cataract patient from the Black Hills Regional Eye Institute, please use this cataract post-op form.

Laser Vision Pre-Op Form:

If you are a doctor’s office caring for a LASIK patient from the Black Hills Regional Eye Institute, please use this pre-op form.

Laser Vision Post-Op Form:

If you are a doctor’s office caring for a LASIK patient from the Black Hills Regional Eye Institute, please use this LASIK post-op form.

Hotel Listing:

Location Maps

Liaison Contact Information

Vannessa Simmons

Optometric Liaison

| 605-719-3157 | [email protected]

Please contact if you need forms, books, maps, or any other information regarding the Eye Institute.