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	Informed Consent Documents
	Ophthalmic Risk Management Forms & Documents is published by the Ophthalmic Mutual Insurance Company (OMIC), a risk retention group, for educational purposes only. It is intended solely to provide general information on a number of medical and legal issues. It is not intended to constitute legal counsel and should not be relied on as a source for legal advice. If legal advice is desired or needed, an attorney should be consulted.
	The following forms are in Rich-Text Format (RTF). If you are on a PC, your browser will use a word-processing application such as MS Word to open the document within your browser window. If you are on an Apple computer, the file will be downloaded to a designated folder or your desktop. Click here for consent forms in Spanish. Cataract Surgery Consent Forms Cataract Consent Form Patient Information Sheet Cataract Surgery Risk Management Recommendations Endophthalmitis/TASS Recommendations and AAO/ASCRS Reports Endophthalmitis/TASS Investigation Protocol Intraoperative Floppy Iris Syndrome A syndrome named intraoperative floppy iris syndrome or IFIS has been linked to a medication called Flomax, which is prescribed for men with prostatic hypertrophy and women with urinary retention. Click here to link to an AAO article by Dr.David F. Chang that gives recommendations on how to prepare for and manage it. Please click here for the AAO/ASCRS Educational Statement: YAG Capsulotomy Back To Top Corneal Surgery DSEK Corneal Transplant Surgery DSEK Corneal Transplant Surgery Recommendations Mitomycin-C Treatment for Conjunctival and Corneal Disorders Courtesy of Bernard H. Chang, MD, a practicing ophthalmologist in Nashville, TN.) Phototherapeutic Keratectomy (PTK) Consent Form PKP Corneal Transplant Surgery Pterygium Surgery Consent Form Back To Top Glaucoma Surgery Consent Forms Argon Laser Trabeculoplasty (ALT) Selective Laser Trabeculoplasty(SLT) Glaucoma Filtering Surgery (Trabeculectomy) Consent Form Mitomycin-C and 5-Fluorouracil in Glaucoma Filtering Surgery (Courtesy of B. Thomas Hutchinson, MD, a practicing ophthalmologist in Boston, MA.) General Consent for Glaucoma Surgery Addendum to General Consent for Glaucoma Surgery: Laser Iridotomy (Iridectomy) Addendum to General Consent for Glaucoma Surgery: Ciliary Body Glaucoma Treatments Back To Top Oculoplastic/Eyelid Procedures Blepharoplasty (Eyelid Tuck or Lift) Consent Form Botox Use Consent Form Botox Recommendations Juvederm Consent Form Chalazion: Incision and Drainange of Chalazion Consent Form CO2 Laser Skin Resurfacing Consent Form Dacryocystorhinostomy (DCR) Consent Form GentleMAX Laser Treatment Consent Form (Courtesy of John W. Shore, M.D., a practicing ophthalmologist in Austin, Texas.) Latisse™ Treatment Consent Form (Courtesy of John W. Shore, M.D., a practicing ophthalmologist in Austin, Texas.) Click here for the AAO prescribing recommendations for Latisse. Ptosis Surgery Consent Form Punctal Plugs Consent Form (Courtesy of Bernard H. Chang, MD, a practicing ophthalmologist in Nashville, TN.) Restylane Injection Consent Form Tumescent Liposuction Surgery Consent Form (Courtesy of Emilio M. Justo, MD, a practicing ophthalmologist in Sun City West, AZ.) Back To Top Strabismus Strabismus Surgery Consent Form Back To Top Retinal Procedures Avastin™ Consent Form Avastin™ Recommendations Fluorescein Angiography Consent Form Fluorescein Angiography Recommendations Lucentis™ Consent Form Lucentis™ recommendations Macugen™ Consent Form OZURDEX™ Consent Form Periocular Repository Corticosteriod Injections Photodynamic Therapy with Visudyne® Consent Form Retisert™ Consent form Retisert™ Recommendations ROP: Consent for Laser Surgery Scleral Buckle Consent Form Triamcinolone Acetonide (Kenalog™ Triesence™ Trivaris™) Consent Form Triamcinolone Acetonide Recommendations and Consent form Vitrectomy Consent form Back To Top Miscellaneous Consent Forms Dilating Eye Drops Consent Form Informed Consent for Off-label Use of a Drug or Device Refusal of Recommended Medical or Surgical Procedure/Intervention Back To Top Refractive Surgery Consent Forms AK Consent Form Informed Consent for Astigmatic Keratotomy Conductive Keratoplasty Consent Forms Informed Consent for Conductive Keratoplasty (CK) for the Correction of Hyperopia (Farsightedness) Informed Consent for NearVision^SM CK Addendum: Consent for Bilateral Simultaneous CK for Treatment of Hyperopia Intacs Consent Forms Informed Consent for Keravision® Intacs™ Addendum: Consent for Bilateral Simultaneous Intacs for Treatment of Myopia Intacs: Consent for Off-Label Therapeutic Use for Post-LASIK Ectasia IntraLASIK Consent Form IntraLASIK Consent LASIK Consent Forms LASIK Consent Addendum: Consent for Bilateral Simultaneous LASIK LASIK Retreatment Consent LASIK Retreatment Original Flap Assumption of LASIK post-op Care Phakic Consent Forms Phakic Implant Verisyse™ Informed Consent Verisyse™ Recommendations Visian ICL™ Phakic Implant Surgery Recomnmendations for Visian ICL™ Phakic Implant Surgery PRK Consent Forms Photorefractive Keratectomy (PRK) Consent Form Addendum: Consent for Bilateral Simultaneous PRK Suggested Informed Consent Clauses for Documenting "Off-label" PRK Addendum: MMC with Refractive Surgery Refractive Lens Exchange Consent Form Informed Consent for Refractive Lens Exchange Consent for Comanagement After Eye Surgery Wavefront Addendum (Courtesy of David A. Wallace, MD, a practicing ophthalmologist in Santa Monica, CA.) General Consent Form with Addendum General Consent for Medical and Surgical Procedures Addendum to General Consent Form: Corneal Surgery Addendum to General Consent Form: Glaucoma Surgery Addendum to General Consent Form: Laser Surgery Addendum to General Consent Form: Orbital and Plastic Surgery Addendum to General Consent Form: Retina Surgery Addendum to General Consent Form: Strabismus Surgery Addendum to General Consent Form: Vitrectomy Surgery Back To Top Back to Top\|Home\|Copyright, Disclaimer and Privacy Statement © 2006 Ophthalmic Mutual Insurance Company, A Risk Retention Group