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Check My Macula Check My Macula Join the Community Join the Community Order Free Information Order Free Information Call our helpline at 1800111709 Helpline
1800 111 709
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      • What Happens?
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      • Treatment
      • Charles Bonnet Syndrome
      • Cataracts and Macular Degeneration
      • Frequently Asked Questions
    • Diabetic Retinopathy
      • About Diabetic Retinopathy
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      • What Happens?
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      • Best Disease
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      • Retinal Detachment
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      • Retinal Vein Occlusion
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      • Central Serous Chorioretinopathy (CSC)
      • Posterior Vitreous Detachment and Floaters
      • Vitreomacular Traction Syndrome
    • Visit Eye Health Professional
      • Eye Injection Costs and Rebates
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      • Anti-VEGF injections for macular disease
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      • Understanding Research
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Macular Disease Foundation Australia
Check My Macula Macula Join the Community Join Us Order Free Information Free Info Donate Donate
Menu
  • My Cart
    • Language
      • English
      • Arabic
      • Chinese
      • Greek
      • Italian
      • Portuguese
      • Spanish
      • Vietnamese
    • Home
    • Macular Disease
      • Macular Degeneration
        • About Macular Degeneration
        • Check My Macula
        • What Happens?
        • Risk Factors
        • Prevention
        • Detection
        • Diagnosis
        • Treatment
        • Charles Bonnet Syndrome
        • Cataracts and Macular Degeneration
        • Frequently Asked Questions
      • Diabetic Retinopathy
        • About Diabetic Retinopathy
        • About Diabetes
        • What Happens?
        • Risk Factors
        • Prevention
        • Detection
        • Diagnosis
        • Treatment
        • Frequently Asked Questions
      • Low Vision
        • Living with Low Vision
        • Carer and Family
        • Aids and Technology
        • Slips, Trips and Falls
        • Legal blindness
      • Other Macular Diseases
        • Best Disease
        • Macular Hole
        • Macular Pucker
        • Macular Telangiectasia
        • Myopic Macular Degeneration
        • Retinal Detachment
        • Retinitis Pigmentosa
        • Retinal Vein Occlusion
        • Stargardt Disease
        • Central Serous Chorioretinopathy (CSC)
        • Posterior Vitreous Detachment and Floaters
        • Vitreomacular Traction Syndrome
      • Visit Eye Health Professional
        • Eye Injection Costs and Rebates
      • Macular Disease
        • Anti-VEGF injections for macular disease
    • Research
      • Research Grants Program
        • Research Grants Awarded
        • Research Grant Recipients
        • Apply for the MDFA Research Grants Program
        • Research Grants Panel
      • Support Research
      • Latest Research
        • Research News
        • MDFA Research
        • Macular Diseases
        • Understanding Research
        • Social Impact
      • Research Updates
        • Annual Research Update
        • Weekly Research Updates for Professionals
      • Research studies
    • Resources
      • Order Publications and Resources
      • Find a Healthcare Provider
      • Audio and Video
        • Audio
        • Podcasts
        • Patient Voices
        • Videos
      • Macula Menus
      • Check My Macula toolkits
      • Aged care resources
    • News & Events
      • Newsletters
        • Vision Voice Newsletters
        • Subscribe to Newsletters
        • Archive
      • News
        • 2021 news
        • 2020 news
        • 2019 News
        • 2018 News
        • 2017 News
        • 2016 News
        • Archived News
      • Events & Activities
        • Community Events
        • Education Sessions
        • Events Calendar
        • Watch past webinars
      • Media Centre
        • Media Releases
    • Foundation
      • Organisation
        • History
        • Objectives
        • Guiding Principles
        • Annual Reports
        • Whistleblower Policy
        • Financial Statements
      • People
        • Patron
        • State Patrons / Representatives
        • Ambassadors
        • Foundation Board
        • Committees
        • State Chairs
        • National Research Advisor
      • Our Work
        • Awareness
        • Education
        • Support Services
        • Research
        • Representation
      • Support Us
        • Donate
        • Bequests
        • Fundraise
        • Volunteer
        • Friends of the Foundation
        • Sponsors and Supporters
        • Professional Friends
      • Contact Us
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  • Macular Disease Foundation Australia e-Referral Form
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Macular Disease Foundation Australia e-Referral Form

Macular Disease Foundation Australia (MDFA) is a charity with a mission to reduce the incidence and impact of macular disease in Australia.

MDFA is committed to supporting the needs of those with macular disease, including their family and carers.

For privacy compliance purposes, it is important that patients understand that you will be sharing their personal information.

MDFA will collect and use this personal information in accordance with its privacy policy available at: www.mdfoundation.com.au/privacy-policy


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Practitioner's Details

Please ask clients to agree to this statement:

“I agree for this practice to provide my personal information (name, contact details, information about my eye health) to Macular Disease Foundation Australia so that they can contact me with information about macular disease and MDFA’s services.”
 

Patient Details
To ensure we comply with Australian privacy laws, please do not provide clinical information in the box below

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