For Doctors

At Chelmsford Optometric Associates, we provide the highest quality service to all our patients. In order to refer a patient, please fax over the last completed doctor's note to the office at and use the form below to request the appointment. Please indicate the preferred date and time. Please note that we will reach out to the patient to first to confirm the appointment or to provide them with an alternative date. You may also call us to request an appointment. Thank you!


Referring Provider Details

​​​​​​​Patient Contact Information

​​​​​​​Patient Insurance

​​​​​​​Appointment Preferences