Request Retina IQ

Why request Retina IQ?

Expert second-opinion support for retinal imaging.

Confidence in normal reads: Supports reassurance when images appear normal.
Subtle abnormal observations: Prompts additional consideration when a scan seems normal but may contain abnormal findings.
Referral confidence: Strengthens abnormal interpretations that require referral when speaking with the patient.
Professional control: Reports go to the eyecare professional, not directly to the patient.
Optional service line: Practices may offer an expert-opinion review as an additional fee-based service.
Tiered Retina IQ pricing: 0–100 scans per month: $15 per scan; 101–300 scans per month: $12 per scan; over 300 scans per month: $10 per scan.

Benefits of Retina IQ

Request details

Provider/site autofill: Select the OD/site once and the request fields below will populate automatically.

Site / Eyecare Professional

Site ID

Street Number and Street Name

City

State

ZIP

Load Previous Patient

Search for Previously Enrolled Patient

Search by last name and/or date of birth to load a previous patient's demographics. All fields can be edited after loading.

Last Name

Date of Birth

Request Date

Requested Priority

Patient First Name

Patient Last Name

Date of Birth

Clinic Patient ID / MRN

Patient Phone, if permitted

PCP / outside records information

Enter PCP information once here so it can be stored with the Retina IQ request and used for downstream medical release / record follow-up when applicable.

PCP First Name, if known

PCP Last Name, if known

PCP Phone / Fax, if known

PCP Practice / Facility, if known

PCP Street Number and Street Name

PCP City

PCP State

PCP ZIP

Patient consent + medical release for Retina IQ

One signature, one document: The Practice Patient Services Consent already contains the HIPAA authorization and the Medical Records Release (section 5). The patient signs once below and the signature page is added to that document — no separate release form.

Patient E-Signature

Signature Date

Patient agrees this typed name is an electronic signature for the SpectOcular Practice Patient Services Consent, which includes the HIPAA authorization and Medical Records Release (section 5).

Information to be released: defined by section 5 of the Practice Patient Services Consent — a comprehensive authorization covering medical history and notes, laboratory results, medications and pharmacy records, retinal and ophthalmic imaging (fundus, OCT, OCT-A), radiology, cardiac testing, procedure reports, vitals, discharge summaries and specialist reports, with longitudinal access until revoked in writing. There is no per-category selection.

Signed consent and medical release PDF uploaded to the SpectOcular Google Drive workflow.

Requesting eyecare professional

Select Saved Professional

Practice / Organization

Requesting Professional First Name

Requesting Professional Last Name

Role / Credentials

Professional Email

Professional Phone / Fax

Clinical context for Retina IQ

Scan / Image Date

Modalities Submitted

Color Fundus OCT OCT-A Other

Pertinent Medical History

Pertinent Ocular History

Notes for Retina IQ team and/or Clinical Question

Interpreter: Retina IQ imaging interpretation will be assigned to Sai Chavala, MD, SpectOcular.

Imaging upload: After submitting the request, upload the patient imaging export as a .zip file to the SpectOcular Google Drive workflow.

Upload imaging file (.zip) to SpectOcular

Imaging ZIP uploaded to the SpectOcular Google Drive workflow.

Learn about Research

Request saved locally. Use the email button to send the request to admin@spectocularhealth.com.

Expert second-opinion support for retinal imaging.

Request details

Search for Previously Enrolled Patient

PCP / outside records information

Patient consent + medical release for Retina IQ

SpectOcular Patient Consent — Signature Page

Medical Release — Signature Page

Information to be Released

Requesting eyecare professional

Clinical context for Retina IQ