Risk Management

Risk Management: Consent Forms

Welcome to OMIC’s Consent Form library, a comprehensive collection of loss prevention and patient education and safety templates for ophthalmic practices. Sample Letters and Office Forms are included under the Patient or Practice categories. Translated Forms are accessed through the toolbar of English form. A complete list is included below.

Questions? Suggestions? Contact us: riskmanagement@omic.com.

Anesthesia (2)

General Anesthesia

General Consent for Medical and Surgical Procedures

Cataract (8)

Cataract (and/or Implantation of Intraocular Lens) Consent Form (Spanish Version)

Cataract Consent Form

Cataract. Same Day Sequential Bilateral Surgery Addendum

Cataract: Femtosecond Laser Addendum

Cataract: Patient Information Sheet

Comanagement After Eye Surgery

YAG Capsulotomy

YAG Posterior Capsulotomy (Spanish Version)

Cornea (5)

Cornea Addendum to General Surgery Consent (Spanish Version)

DSEK Corneal Transplant Surgery

Keratoprosthesis (Artificial Corneal Transplant) Consent

Pterygium Consent Form

Pterygium Consent Form (Spanish Version)

Drugs and Devices (10)

Avastin™ (bevacizumab) Consent Form

Cataract Consent Form

Dilating Eye Drops Consent Form

Informed Consent for Off-label Use of a Drug or Device

Intacs. Bilateral Simultaneous Intacs for Treatment of Myopia

Jetrea (ocriplasmin) Consent

Keratoprosthesis (Artificial Corneal Transplant) Consent

LASIK. Bilateral Simultaneous

MMC with Refractive Surgery

PRK: Bilateral Simultaneous

Emergency Room (1)

Refusal of Recommended Medical or Surgical Procedure/Intervention

Glaucoma (7)

Argon Laser Trabeculoplasty (ALT) Selective Laser Trabeculoplasty (SLT)

Glaucoma Addendum to General Surgery Consent (Spanish Version)

Glaucoma Consent

Glaucoma Filtering Surgery (Trabeculectomy) Consent Form

Glaucoma Surgery: Ciliary Body Glaucoma Treatments

Glaucoma: Laser Iridotomy or Iridectomy

Mitomycin-C and 5-Fluorouracil in Glaucoma Filtering Surgery

Neuro (0)
Oculoplastics (14)

Blepharoplasty (Eyelid Tuck or Lift) Consent Form

Botox Use Consent Form

Chalazion: Incision and Drainage of Chalazion Consent Form

CO2 Laser Skin Resurfacing Consent Form

Dacryocystorhinostomy (DCR) Consent Form

GentleMAX Laser Treatment Consent Form

Juvederm Consent Form

Latisse™ Treatment Consent Form

Orbital and Plastics Addendum to General Surgery Consent (Spanish Version)

Ptosis Surgery Consent Form

Punctal Plugs Consent Form (Courtesy of Bernard H. Chang, MD, a practicing ophthalmologist in Nashville, TN.)

Restylane Injection Consent Form

Strabismus Addendum to General Surgery Consent (Spanish Version)

Tumescent Liposuction Surgery Consent Form

Pediatric (5)

ROP. Parents: Read This About Your Premature Baby's Eyes!

ROP: Consent for Laser Surgery

ROP: Intravitreal Anti-VEGF Injections

Strabismus Addendum to General Surgery Consent (Spanish Version)

Strabismus Surgery Consent Form

Retina (16)

Avastin (bevacizumab) (Spanish Version)

Avastin™ (bevacizumab) Consent Form

Eylea™ (aflibercept) Consent

Fluorescein Angiography Consent Form

Jetrea (ocriplasmin) Consent

Laser Addendum to General Surgery Consent (Spanish Version)

Lucentis™ (ranibizumab) Consent

Macugen™ Consent Form

Ozurdex™(dexamethasone) Consent

Periocular Repository Corticosteriod Injections

Photodynamic Therapy with Visudyne® Consent Form

Retina Addendum to General Surgery Consent (Spanish Version)

Retisert™ Consent form

ROP: Intravitreal Anti-VEGF Injections

Triamcinolone Acetonide (Kenalog™ Triesence™ Trivaris™) Consent Form

Vitrectomy Addendum to General Surgery Consent (Spanish Version)

Refractive (25)

AK Consent Form

Comanagement After Eye Surgery

Conductive Keratoplasty (CK) for Hyperopia

Conductive Keratoplasty NearVisionSM CK

Conductive Keratoplasty. Bilateral Simultaneous CK for Hyeropia

Intacs. Bilateral Simultaneous Intacs for Treatment of Myopia

Intacs: Consent for Off-Label Therapeutic Use for Post-LASIK Ectasia

Intacs™ by Keravision® for Myopia

LASIK Consent

LASIK Consent Form (Spanish Version)

LASIK Retreatment Consent

LASIK Retreatment Original Flap

LASIK. Bilateral Simultaneous

LASIK: Assumption of post-op care

LASIK: Bilateral Simultaneous Surgery (Spanish Version)

LASIK: IntraLASIK Consent Form

MMC with Refractive Surgery

Phakic Implant Verisyse™ Informed Consent

Photorefractive Keratectomy (PRK) Consent Form

PRK Consent Form (Spanish Version)

PRK. "Off-label"

PRK: Bilateral Simultaneous

Refractive Lens Exchange (RLE)

Visian ICL™ Phakic Implant Surgery

Wavefront Addendum

Patient (7)

General Consent for Medical and Surgical Procedures

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Covered Benefit" (Sample Letter)

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Medically Necessary" (Sample Letter)

Online Communications Informed Consent

Refusal of Recommended Medical or Surgical Procedure/Intervention

Termination of Care (Sample Letter in Spanish)

Termination of Care (Sample Letter)

Practice (6)

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Covered Benefit" (Sample Letter)

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Medically Necessary" (Sample Letter)

Referral Form for Managed Care Patients

Surgery Face Sheet

Termination of Care (Sample Letter in Spanish)

Termination of Care (Sample Letter)

Surgery (4)

General Consent for Medical and Surgical Procedures

General Consent Form (Spanish Version)

Refusal for Surgery Consent

Surgery Face Sheet

Translated Forms

Spanish (14)

Pterygium Consent Form (Spanish Version)

YAG Posterior Capsulotomy (Spanish Version)

Strabismus Addendum to General Surgery Consent (Spanish Version)

Vitrectomy Addendum to General Surgery Consent (Spanish Version)

Retina Addendum to General Surgery Consent (Spanish Version)

Orbital and Plastics Addendum to General Surgery Consent (Spanish Version)

Laser Addendum to General Surgery Consent (Spanish Version)

General Consent Form (Spanish Version)

Cataract (and/or Implantation of Intraocular Lens) Consent Form (Spanish Version)

LASIK: Bilateral Simultaneous Surgery (Spanish Version)

LASIK Consent Form (Spanish Version)

PRK Consent Form (Spanish Version)

Avastin (bevacizumab) (Spanish Version)

Termination of Care (Sample Letter in Spanish)


books

Six reasons OMIC is the best choice for ophthalmologists in America.

#5. Expertise unmatched.

OMIC’s sole mission is to serve ophthalmology. The premier source of ophthalmic claims data and loss
prevention materials, OMIC’s member hotline is the most used ophthalmic consultative service of its kind and OMIC.com is the most visited web site in America for ophthalmic risk management advice and patient consent documents.