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Patient Forms
For your convenience, some of the
forms that will be needed when you come to our office are listed below.
Please feel free to complete these forms ahead of time.
If you are experiencing problems
printing or viewing the forms, please call us
toll free: 1-800-644 -6393, or
email us and we will be happy to fax or mail you a copy.
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Patient Intake Forms
Patient Information
Record
A general Patient Information form for you to
fill out and bring to our office the day of your consultation.
Pre-Procedure Patient Examination
Download and fill out the "History of Present
Condition" portion of this form and bring to our office the day of
your pre-procedure examination.
Consent Forms
Epi-Laser (No-Cut or
Flap) Laser
Vision Correction Consent Form
Patient consent forms that
must be filled out in order to have the Epi-Laser No-Cut laser vision correction surgery.
SBK-LASIK (Thin Flap)
Laser Vision Consent Form
Patient consent forms
that must be filled out in order to have the SBK-LASIK vision correction surgery.
Femto-LASIK Consent Form
Patient consent forms
that must be filled out in order to have the LDV Femtosecond LASIK vision correction surgery.
Informed Consent
for Laser Vision Retreatment
Patient consent form that must be filled out in order to have a
retreatment procedure following other refractive and surgical
procedures.
Consent Form for Corneal
Relaxing Incisions for Astigmatism
Patient consent form that must be filled out in order to have the
Corneal Relaxing Incisions for Astigmatism procedure.
Consent Form For Treatment
of Dry Eye with SmartPlug®
Patient consent form that must be filled out to have the
SmartPlug treatment for dry eye syndrome.
Patient Education Forms
Laser
Vision Myths
There are many
conflicting stories about Laser Vision Correction. This makes
information about Laser Vision Correction confused and hard to
understand. Read 'Laser
Vision Myths' and we’ll let you decide.
What
to Expect on Your Surgery Day
Download, print and read at your convenience, our information page
on what you can expect on the day of your laser vision corrective
procedure.
After
Your Surgery
Download, print and read at your convenience, our
information page on what you can expect after your laser vision
corrective procedure.
Back to the top.
Call for a
FREE consultation!
260-486-0065 or toll free 1-800-644-6393!
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