Are you an optometrist needing to refer a Dorset patient into the hospital on a rapid access pathway for AMD? Dorset now has an editable referral form to use to ensure the right information is sent in with the patient, aiding a faster and more accurate triage. The Form is in Word and can be filled in an attached to the email. You can also use Word online through your NHS mail account.

The form contains referral guidance to aid appropriate referrals. Please note, patients with suspected diabetic maculopathy should be referred via the Dorset Diabetes Eye Screening Programme, and not via the rapid access pathway.

This form is for use by optometrists only, for Dorset patients.

A variety of images of advanced, drusen, and wet AMD.

Use image to assist with your referral.

The Dorset referral form and imagery used are based on the work of the Thames Valley Macular Group, namely: Susan Downes, Consuela Moorman, Lyn Jenkins and Sarah Lucie Watson. The Royal College of Ophthalmologists has highlighted their work as an example of good practice.

If you have any queries relating to the use of this form, please contact