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.

Request details

Provider/site autofill: Select the OD/site once and the request fields below will populate automatically. New sites should be added in the Google backend Sites tab; no website rebuild is needed.

Site / Eyecare Professional

Site ID

Street Number and Street Name

City

State

ZIP

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 patient e-signature applies to both documents: The patient signs once below. The signature is copied into the SpectOcular Patient Services Consent and the Medical Release PDF packet.

Patient E-Signature

Signature Date

Patient agrees this typed name is an electronic signature for the SpectOcular Patient Services Consent and Medical Release.

Medical Release — Information to be Released

The Medical Release PDF keeps this section blank until the boxes below are checked. Checked items populate the signed PDF packet.

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.

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

Expert second-opinion support for retinal imaging.

Request details

PCP / outside records information

Patient consent + medical release for Retina IQ

Medical Release — Information to be Released

SpectOcular Patient Consent — Signature Page

Medical Release — Signature Page

Information to be Released

Requesting eyecare professional

Clinical context for Retina IQ