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 mail you a copy.
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Preoperative Forms
Patient Information
Record
A general Patient Information form for you to
fill out and bring to our office the day of your consultation.
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.
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.
Consent Forms
Amoils Advanced
Surface Laser Vision Treatment (Superficial Epi-Laser) Consent Form
Patient consent
forms that must be filled out in order to have the Amoils Advanced
Surface (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 Treatment
of Dry Eye with SmartPlug®
Patient consent form that must be filled out to have the
SmartPlug treatment for dry eye syndrome.
Consent From For
Treatment of Epithelial In-Growth (Off Label)
Patient consent form that must be filled out in order to
have the treatment performed for epithelial in-growth.
Postoperative Form:
Postoperative Patient Instructions
Download, print and read at your convenience, our patient
postoperative instructions on how to use your medications,
protecting your eyes, and sunglasses to use after your surgery is
complete.
Patient Education Form:
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.
Back to the top.
To Schedule
Consultation &
Treatment on Same Day
With Dr. Shealy, Give Us a Call at 1-800-644-6393 or
Email Us!
Shealy Eye Laser Center
6036 Trier Road Fort Wayne, IN 46815 ♦
Tel: (260) 486-0065 or (800) 644-6393 ♦ email:
shealy@shealyeye.com
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