Policyholder Services



New Consent Form: Permanent Punctal Occlusion Consent Form

Save this form to your computer by clicking the DOWNLOAD button above.

The permanent punctal occlusion consent form was provided by OMIC Claims and Risk Management Committee member Steven I. Rosenfeld, MD, FACS. Dr. Rosenfeld is a board-certified, fellowship-trained ophthalmologist who specializes in medical and surgical treatments of corneal conditions, infectious and inflammatory eye diseases, and all forms of laser vision correction. Dr. Rosenfeld practices with Delray Eye Associates, PA in Delray Beach, Florida.

This form is intended as a sample form. It contains information OMIC recommends you as the surgeon personally discuss with the patient. Please review it and modify to fit your actual practice.

Please refer to OMIC's Copyright and Disclaimer regarding the contents on this website

Leave a comment



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

Largest insurer in the U.S.

OMIC is the largest insurer of ophthalmologists in the United States and we've been the only physician-owned carrier to continuously offer coverage in all states since 1987. Our fully portable policy can be taken with you wherever you practice. Should you move to a new state or territory, you're covered without the cost or headache of applying for new coverage.

61864684