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
64
resources.
Apr 8, 2026
| Consent Form
...that you have 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:...
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
...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 is...
Aug 25, 2024
| Consent Form
...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 surgery...
Apr 8, 2026
| Consent Form
...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 correction:...
Apr 8, 2026
| Consent Form
...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 IOL...
Apr 8, 2026
| Consent Form
[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 eyes...
Apr 9, 2026
| Consent Form
...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 puts in a new artificial lens called an intraocular lens or IOL. Cataract surgery will not correct other...
Apr 23, 2026
| Consent Form
...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 of a suitable artificial intraocular lens. · [State the need for follow-up after surgery, e.g.:] Careful...
Apr 22, 2026
| Consent Form
...eye, with the 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...
Apr 8, 2026
| Consent Form
...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 as...
Apr 9, 2026
| Consent Form
...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 capsule)...
Apr 22, 2026
| Consent Form
...there is no cataract. In some cases, the lens may have an early cataract which does not significantly interfere with corrected vision, and which would normally not require surgical removal. The eye surgeon, known as an ophthalmologist, surgically removes the natural lens of the eye and replaces it with an...
Apr 9, 2026
| Consent Form
...· 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 discomfort...
Apr 9, 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 the...
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) ·...
Apr 8, 2026
| Consent Form
...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 glaucoma...
Apr 8, 2026
| Consent Form
...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 as...
Apr 8, 2026
| Consent Form
...· 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 surgery...
Feb 13, 2020
| Consent Form
...soon after surgery 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...
Apr 8, 2026
| Consent Form
...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 glaucoma...
Apr 8, 2026
| Consent Form
...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 · Double...
Apr 9, 2026
| Consent Form
...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 lasts...
Apr 9, 2026
| Consent Form
...· 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 discomfort...
Apr 9, 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 tissue...
Apr 9, 2026
| Consent Form
...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 last...
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 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 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...
Apr 23, 2026
| Consent Form
...risks and complications of Iridotomy are: · Potential complications of either a YAG-laser iridotomy or a surgical iridotomy are very rare, but include damage to the natural lens; inflammation inside the eye; temporary increases in the pressure in the front part of the eye; cataract formation; bleeding (usually a small...
Apr 8, 2026
| Consent Form
...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 a...
Apr 22, 2026
| Consent Form
...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 no...
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...
Apr 9, 2026
| Consent Form
...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 vision, which may...
Apr 8, 2026
| Consent Form
...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: · PK...
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
...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 and...
Apr 22, 2026
| Consent Form
...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 best-corrected vision was [INSERT]. [1: This template assumes that cataract surgery was...
Apr 24, 2026
| Consent Form
...can be corrected by glasses or contact lenses. 5. I 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....
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,...
Dec 1, 2025
| Consent Form
...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: · You...
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...
Apr 22, 2026
| Consent Form
...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 to...
Apr 23, 2026
| Consent Form
...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 the...
Apr 23, 2026
| Consent Form
...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 increased...
These are sample forms—download, review and revise as needed.