Medical providers at community clinics refer eligible patients to Operation Access for surgery, using a one-page referral form. Operation Access staff contact patients to conduct an eligibility screening by phone. For eligibility criteria, click here.

If you qualify, Operation Access will arrange a consultation and surgery with a surgeon at a local hospital at no charge. An interpreter is provided by Operation Access whenever necessary.

After the post-operative appointment, patient returns to the referring clinic for ongoing medical care.

Click on a link below to download our referral form:

Download our Alameda County Referral Form (pdf)

Download our Alameda County Eye Clinic Referral Form (pdf)
Download our Contra Costa County Referral Form (pdf)

Download our Marin County Referral Form (pdf)

Download our San Francisco County Referral Form (pdf)

Download our San Mateo County Referral Form (pdf)

Download our Sonoma County Referral Form (pdf)

Download our general referral form (pdf)

To download Adobe acrobat click here

Additional information links:
Eligibility criteria

Procedure Types Available
Participating Hospital Map
FAQs