Consent Forms
Welcome to OMIC’s Consent Form library, a collection of procedure-specific consent forms that you can modify to suit your practice and patient population. Contact riskmanagement@omic.com with questions.
Found
66
resources.
Apr 8, 2026
| Consent Form
...Cataract Surgery You have [Condition], and your doctor, [Name, MD/DO], is recommending Laser Assisted Cataract surgery. What is Laser Assisted Cataract Surgery? The femtosecond laser (FS laser) is a medical tool the eye surgeon may use to perform some of the steps of cataract surgery. About Laser Assisted Cataract Surgery...
Apr 9, 2026
| Consent Form
...as a cataract. Cataracts can develop from normal aging, from an eye injury, or if you have taken medications known as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. About Cataract Surgery If the cataract changes vision so much that it interferes...
Apr 9, 2026
| Consent Form
...be removed. Surgery is the only way to remove a cataract. You can decide not to have the cataract removed. If you don’t have the surgery, your vision loss from the cataract will continue to get worse. HOW WILL REMOVING THE CATARACT AFFECT MY VISION? The goal of cataract surgery...
Aug 25, 2024
| Consent Form
...HOW WILL REMOVING THE CATARACT AFFECT MY VISION? The goal of cataract surgery is to correct the decreased vision that was caused by the cataract. During the surgery, the ophthalmologist (eye surgeon) removes the cataract and may place in a new artificial lens called an intraocular lens or IOL. Cataract...
Apr 8, 2026
| Consent Form
...SURGERY CENTER AS VERIFICATION THAT YOU HAVE OBTAINED INFORMED CONSENT. KEEP THE ORIGINAL IN THE PATIENT’S MEDICAL RECORD. There are four parts to the plain language cataract consent forms: Use the main cataract consent form for all patients having cataract surgery www.omic.com/cataract-plain-language-consent-forms/ · Add an addendum if needed: · Astigmatism...
Apr 8, 2026
| Consent Form
...obtained informed consent. Keep the original in the patient’s medical record. Version 07/01/2015 ) There are four parts to the plain-language cataract consent forms: · Use the main cataract consent form for all patients having cataract surgery www.omic.com/cataract-plain-language-consent-forms/ · Add an addendum if needed: · Astigmatism correction: use for toric...
Apr 8, 2026
| Consent Form
50086 [bookmark: _GoBack]Add your letterhead to the first page of the consent form Change font size for large print. 1/7/19 IMMEDIATE SEQUENTIAL BILATERAL CATARACT SURGERY My ophthalmologist (eye physician and surgeon) has determined that I have cataracts in both eyes. I would like to have the surgery done on both...
Apr 9, 2026
| Consent Form
...a cataract. [Include a statement:] This is an elective procedure. You do not have to proceed with cataract surgery. If you don’t have the surgery, your vision loss from the cataract will continue to get worse. Benefits How will removing the cataract affect my vision? The goal of cataract surgery...
Sep 14, 2026
| Consent Form
...low light, for reading or, for all of these activities. · With increasing age, patients are likely to develop cataracts. If the cataracts are significant enough to cause visual problems, the phakic implant may need to be removed so that the eye can undergo cataract removal with or without implantation...
Sep 11, 2026
| Consent Form
...Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding tissues that may last · Drooping of the eyelid...
Sep 11, 2026
| Consent Form
...need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball · Infection · Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time...
Apr 9, 2026
| Consent Form
...MD/DO], is recommending Laser Capsulotomy after Cataract surgery. What is YAG Laser Capsulotomy? YAG Capsulotomy is a laser treatment used to improve vision after cataract surgery, and is usually performed as an outpatient. A common occurrence after cataract surgery is clouding of the part of the natural lens covering (the...
Sep 15, 2026
| Consent Form
...For the Correction of Hyperopia (Farsightedness) Or Myopia (Nearsightedness) INTRODUCTION This surgery, called a refractive lens exchange or RLE, involves the removal of the clear lens of your eye, even though there is no cataract. In some cases, the lens may have an early cataract which does not significantly interfere...
Sep 10, 2026
| Consent Form
...eyeball · Infection, soon after surgery or years later · Bleeding in the eye · Inflammation · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or...
Sep 10, 2026
| Consent Form
...· Damage to the eyeball · Bleeding in the eye · Infection · Inflammation · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma procedure) · Pain, irritation, or discomfort in...
Apr 22, 2026
| Consent Form
...years later · Bleeding in the eye · Inflammation · Mechanical problem with an implant requiring removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as the glaucoma surgery) ·...
Sep 10, 2026
| Consent Form
...or months or years later · Bleeding in the eye · Inflammation · Mechanical problem with an implant requiring removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as the...
Sep 10, 2026
| Consent Form
...need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball · Infection · Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time...
Sep 10, 2026
| Consent Form
...surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball · Infection, soon after surgery or months or years later · Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract...
Sep 11, 2026
| Consent Form
...removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding tissues that may persist · Drooping of...
Sep 11, 2026
| Consent Form
...is too low · Damage to the eyeball · Infection · Bleeding in the eye · Inflammation · Mechanical problem with an implant requiring removal or repositioning · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this...
Sep 11, 2026
| Consent Form
...Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding tissues that may last · Drooping of eyelid ·...
Sep 16, 2026
| Consent Form
...years later · Inflammation · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Droopy eyelid · Pain, irritation, or discomfort in the eye or surrounding tissues that may...
Sep 16, 2026
| Consent Form
...later · Bleeding in the eye · Inflammation · Mechanical problem with an implant requiring removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or...
Sep 16, 2026
| Consent Form
...· Inflammation · Mechanical problem with an implant requiring removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding...
Sep 16, 2026
| Consent Form
...to the eyeball · Infection · Bleeding in the eye · Inflammation · Cataract (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding tissues that may...
Apr 23, 2026
| Consent Form
...blood flow to parts of the eye Retinal detachment with the need for another surgery to repair it Cataract, or clouding of the lens in your eye. You may need surgery to remove the cataract if it interferes with your vision. Elevated eye pressure (glaucoma) Damage to the cornea, the...
Apr 8, 2026
| Consent Form
...problem with an implant requiring removal or repositioning · Cataract or clouding of the lens (except if you have already had cataract surgery or if you are having cataract surgery at the same time as this glaucoma surgery) · Pain, irritation, or discomfort in the eye or surrounding tissues that...
Apr 22, 2026
| Consent Form
...implant. While your eye surgeon cannot tell you about every risk, here are some of the most common or serious ones: · Risks from steroids · Cataract (clouding of the eye’s lens) leading to the need for cataract surgery · High eye pressure, leading to optic nerve damage and glaucoma,...
Apr 23, 2026
| Consent Form
...YUTIQ contains a steroid. While your ophthalmologist cannot tell you about every risk, here are some of the most common and serious ones: · Risks from steroids · Cataract (clouding of the eye’s lens) leading to the need for cataract surgery · High eye pressure, leading to optic nerve damage...
Sep 16, 2026
| Consent Form
...lens, the Phakic implant, and insertion of an artificial lens. Patients with high levels of nearsightedness are at higher risk for cataract development, and that risk may be increased with implantation of the Phakic IOL. · Corneal swelling (edema) and/or ongoing loss of cells lining the inner surface of the...
Apr 8, 2026
| Consent Form
...corneal melt with perforation, scarring of the conjunctiva or cornea, iritis, glaucoma, cataracts, and possible need for further surgery. *FDA status of MMC in Eye surgery MMC was approved by the Food and Drug Administration (FDA) for the treatment of various types of cancer. Upon approval, the drug manufacturer produces...
Sep 11, 2026
| Consent Form
...be permanent. · Infection, which if severe could result in the loss of the eye · Corneal edema · Corneal perforation, which could lead to infection, or, rarely, a cataract · Decrease in best-corrected visual acuity · Other procedures may be required to reach the desired result. While there is...
Apr 22, 2026
| Consent Form
...Detached retina (the light-sensitive part of the back of your eye might get pulled off) · Cataracts (clouding of the eye’s lens) · Glaucoma (increased eye pressure) · Hypotony (reduced eye pressure) · Retina or cornea damage · Bleeding within the eye · Inflammation inside the eye that can cause...
Apr 22, 2026
| Consent Form
...vision may get worse. · Lucentis injections can cause other eye problems such as: · An eye infection · Detached retina (the light-sensitive part of the back of your eye might get pulled off) · Cataracts (clouding of the eye’s lens) · Glaucoma (increased eye pressure) · Hypotony (reduced eye...
Sep 14, 2026
| Consent Form
...and which may require eye drops, laser treatment, or surgery · Poorly healing or non-healing wounds, which may require additional surgery · Corneal clouding and scarring, which may require additional surgery · Cataract (clouding of the natural lens), which may require immediate or eventual removal of the lens · Double...
Sep 10, 2026
| Consent Form
...permanent damage to the corneal transplant. Usually, eye drops can stop rejection. · Ophthalmologists often can do PK surgery at the same time as cataract or glaucoma surgery. This means that patients with those other eye problems might need just one surgery. Disadvantages of PK corneal transplant surgery include: ·...
Apr 23, 2026
| Consent Form
...infection · Detached retina (the light-sensitive part of the back of your eye might get pulled off) · Cataracts (clouding of the eye’s lens) · Glaucoma (increased eye pressure) · Hypotony (reduced eye pressure) · Retina or cornea damage · Bleeding within the eye · Inflammation inside the eye that...
Apr 9, 2026
| Consent Form
...Consent for Comanagement after LAL Cataract Surgery Patient Name: ____________________________ Date of Birth: ___________ Patient Confirmation I understand that my ophthalmologist, Dr. ______________, will be performing eye surgery on me and optometrist, Dr. ________________, will be co-managing my postoperative care. My surgeon has discussed this postoperative care selection with me...
Sep 10, 2026
| Consent Form
...Letter from Surgeon [DATE] Dear Dr. [NAME OF OD]: On [DATE], our patient, [NAME], underwent successful cataract surgery[footnoteRef:1] with implantation of a(n) [SPECIFY TYPE OF IOL] on his/her [SPECIFY OPERATIVE EYE (LEFT OR RIGHT) ] eye. My last postoperative visit with the patient was on [SPECIFY THE DATE] and his/her...
Sep 11, 2026
| Consent Form
...vision include, but are not limited to, corneal swelling, corneal thinning (ectasia), appearance of “floaters” and retinal detachment, hemorrhage, venous and arterial blockage, cataract formation, total blindness, and even loss of my eye. B. NON-VISION-THREATENING SIDE EFFECTS 1. I understand that there is a greater chance that the whites of...
Apr 23, 2026
| Consent Form
...High eye pressure needs to be treated with eye drops. After about two years, many patients need surgery to control the pressure in their eye. · After about two years, almost all patient develop a cloudy lens or cataract and need to have it removed. An artificial lens is inserted,...
Sep 10, 2026
| Consent Form
...will not be able to read printed words more clearly just because you had blepharoplasty. Talk with your ophthalmologist about other ways to improve vision such as with eyeglasses, contact lenses, cataract surgery, or LASIK surgery. It is your choice whether to have blepharoplasty. Here are some other options: ·...
Mar 19, 2023
| Consent Form
...inside the eye that can cause vision loss, pain, or redness Detached retina (the light-sensitive part of the back of your eye might get pulled off) Cataract (clouding of the eye’s lens) Glaucoma (increased eye pressure) Hypotony (reduced eye pressure) Retina or cornea damage Bleeding within the eye Some patients...
Mar 19, 2023
| Consent Form
...the back of your eye might get pulled off) Cataracts (clouding of the eye’s lens) Glaucoma (increased eye pressure) Hypotony (reduced eye pressure) Retina or cornea damage Bleeding within the eye Some patients taking this medication have had heart attack, stroke, or death. The FDA does not know if the...
Apr 21, 2026
| Consent Form
...Your vision may get worse. · Avastin injections can cause other eye problems such as: · An eye infection · Detached retina (the light-sensitive part of the back of your eye might get pulled off) · Cataracts (clouding of the eye’s lens) · Glaucoma (increased eye pressure) · Hypotony (reduced...
Apr 21, 2026
| Consent Form
...are: · Vision loss · Blindness · BEOVU might not improve your vision. Your vision may get worse. · BEOVU injections can cause other eye problems such as: · An eye infection · Detached retina (the light-sensitive part of the back of your eye might get pulled off) · Cataracts...
Sep 14, 2026
| Consent Form
...understand that other very rare complications threatening vision include, but are not limited to, corneal swelling, corneal thinning (ectasia), appearance of “floaters” and retinal detachment, hemorrhage, venous and arterial blockage, cataract formation, total blindness, and even loss of my eye. If the complication happens during surgery, your surgeon may need...
Sep 14, 2026
| Consent Form
...Loss of sharp vision, increased corneal scarring, increased night glare or corneal infection. Any pre-existing viral infections may reappear with the use of post-operative drops. If the cornea has extensive scars, it is possible that a corneal perforation may occur that could produce other changes such as infections, cataracts or...
Sep 14, 2026
| Consent Form
...body feeling in the eye; double or ghost images; patient discomfort; inflammation of the cornea or iris; persistent corneal surface defect; persistent corneal scarring severe enough to affect vision; ulceration/infection; irregular astigmatism (warped corneal surface which causes distorted images); cataract; drooping of the eyelid; loss of bandage contact lens with...
These are sample forms—download, review and revise as needed.