KC Vision Performance works with referring physicians and professionals to provide patients with comprehensive neuro-optometry, low vision, and vision therapy services.

We are grateful to those who take the time to refer for our special area of vision care. If you are a referring physician, your office staff is welcome to call our office at (913) 469-8686 to schedule an appointment when your patient is at your office. We will then follow up with the patient to prepare them to visit our office.

Printable Referral Forms

Download a PDF below and fax it to our office at (913) 469-8688.

• Neuro-Optometry Vision Rehabilitation Referral Form (PDF)
• Low Vision Rehabilitation Referral Form (PDF)
• Vision Therapy Referral Form (PDF)
• Vision Therapy Classroom Checklist (PDF)

E-mail Referral Form