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
56
resources.
Apr 8, 2026
| Consent Form
...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 The eye surgeon uses the laser instead of a surgical blade and...
Apr 9, 2026
| Consent Form
...out of your eye. · [Include a statement:] This is an elective procedure. You do not have to have Laser Suture Lysis. Benefits How will Laser Suture Lysis treat my vision and/or condition [How can this medication help]? The goal of laser suture lysis is to lower your eye pressure...
Apr 29, 2026
| Consent Form
...Laser Iridotomy Surgery Your ophthalmologist (eye surgeon) recommends laser iridotomy surgery. The ophthalmologist uses a laser to create a small hole in your iris. This hole will release fluid from behind your iris. Your iris can then move away from the cornea, and your angle will open. · [Include a...
Apr 22, 2026
| Consent Form
...causes a painless loss of eyesight. In some cases, it can lead to blindness. About Laser Trabeculoplasty Surgery Your ophthalmologist (eye surgeon) recommends Laser Trabeculoplasty surgery. The ophthalmologist will use a laser to open the drainage system in your eye (trabecular meshwork). The surgery helps the fluid flow out of...
Apr 23, 2026
| Consent Form
...problems that could occur following the procedure.] Risks What are the main risks of Retina Laser Surgery (Retinopexy)? There is no guarantee that retina laser surgery will improve your condition. Sometimes it doesn’t work. In addition, retina laser surgery is risky. Sometimes it can make the problem worse, cause an...
Apr 8, 2026
| Consent Form
...monitor your [condition] and to watch for other eye problems. · [State any minor problems that could occur following the procedure.] Risks What are the main risks of Laser Iridoplasty surgery? There is no guarantee that Laser Iridoplasty surgery will improve your condition. Sometimes it doesn’t work. In addition, Laser...
Dec 1, 2025
| Consent Form
...at all times during the laser energy applications. 2. Flash Fires – Utilization of laser energy always raises the possibility of fire-related incidents. These are rare and are preventable by careful maintenance of the surgical equipment and stringent laser safety precautions. Possible Short-term Effects of CO2 Laser Skin Resurfacing Surgery:...
Mar 9, 2023
| Consent Form
...both laser and anti-VEGF injection to treat ROP. Your Ophthalmologist Is Recommending Laser Surgery. Ophthalmologists have been treating ROP with laser surgery for many years. This type of laser surgery is called PRP (pan-retinal photocoagulation). The laser stops the eye from making more of the VEGF chemical. When successful, the...
Apr 9, 2026
| Consent Form
...record. Version 4/2026 [Your Letterhead] Laser Capsulotomy Surgery Consent You have [Condition], and your doctor, [Name, 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...
Apr 23, 2026
| Consent Form
...Including Laser There are several other procedures for the correction of moderate to high myopia. PRK and LASIK do not require an incision into the inside of the eye as does phakic implant surgery. Photorefractive Keratectomy (PRK) uses an excimer laser to reshape the cornea to refocus light rays on...
Apr 24, 2026
| Consent Form
...Finally, the flap is returned to its original position, without sutures. The IntraLASIK surgery also involves two procedures. First, instead of a microkeratome blade, it uses the FDA-approved IntraLasetm laser to create a flap with laser energy. The IntraLase laser is capable of creating extremely precise flaps by producing tiny...
Apr 9, 2026
| Consent Form
...laser energy can be delivered in different ways: · Trans-scleral approach. The ophthalmologist places the laser on the sclera (white wall of the eye), and the laser energy goes through the eye. The laser may damage the sclera. · Endoscopic approach. The ophthalmologist makes a small incision (cut) in the...
Apr 22, 2026
| Consent Form
...tissue back on the eye after the laser treatment, using sutures, according to the ALK procedure method. It is also possible that the flap incision could result in an incomplete flap, or a flap that is too thin. If this happens, it is likely that the laser part of the...
Apr 23, 2026
| Consent Form
...is recommending Retina Laser Surgery (Retinopexy). What is [Condition]? · [State the condition and how it impacts the patient.] About Retina Laser Surgery (Retinopexy) · Retina Lasers are an intense beam of light that can be precisely focused to treat certain diseases of the retina. The retina is a delicate...
Mar 9, 2023
| Consent Form
...for laser surgery. In other babies, the abnormal blood vessels are too far back in the eye to perform laser surgery safely. Other parts of the eye or blood in the eye may block the view to the abnormal blood vessels, making it impossible to perform the laser surgery. As...
Apr 22, 2026
| Consent Form
...combines the creation of a flap with the microkeratome or a laser and the removal of tissue with the excimer laser. PRK involves removing the surface cells on the cornea (“epithelium”) and using the excimer laser to remove tissue from the exposed tissue on the corneal surface. Both procedures have...
Apr 22, 2026
| Consent Form
...pressure with the fewest risks to the patient’s eyesight and overall health. • Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. • If medications and laser treatment do not work well enough, or if patients have trouble...
Apr 8, 2026
| Consent Form
...that lower the eye pressure with the fewest risks to the patient’s eyesight and overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or...
Apr 22, 2026
| Consent Form
...During the re-treatment procedure, after the original flap is lifted, the flap is flipped over out of the way, and the laser application is performed within the corneal bed instead of on the corneal surface as with PRK. The flap is replaced immediately following the laser application. The flap is...
Apr 23, 2026
| Consent Form
...will take place either at the time of surgery by using an instrument (a surgical iridotomy) or within two weeks before the placement of the phakic implant by using a laser (YAG-laser iridotomy). Before phakic implant surgery begins, your pupils will be dilated and you will be given an anesthetic...
Apr 8, 2026
| Consent Form
...implanted. · Endoscopic cyclophotocoagulation: Your ophthalmologist makes an incision (cut) and passes a light into the eye to guide the laser. The laser treat the cells in the eye that make fluid. The cells create less fluid, and your eye pressure goes down. No device is implanted. Benefits (how the...
Apr 8, 2026
| Consent Form
...patient’s eyesight and overall health. Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and...
Feb 13, 2020
| Consent Form
...alternatives are there for my condition (choices and options)? Express Shunt surgery is not the only option. Your other treatment choices may include: · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser...
Apr 8, 2026
| Consent Form
...overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and other...
Apr 9, 2026
| Consent Form
...drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and other difficulties, then glaucoma surgery is...
Apr 9, 2026
| Consent Form
...may include: · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and other...
Apr 9, 2026
| Consent Form
...choices may include: · Usually eye drop medications or laser surgery are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and...
Apr 23, 2026
| Consent Form
...that you have obtained informed consent. · Keep the original in the patient’s medical record. Version 10/09/2014 CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY Dr. has described to me a procedure called Phototherapeutic Keratectomy (PTK). PTK is done by using the Excimer Laser. The Excimer Laser is used to remove scars, smooth the...
Apr 23, 2026
| Consent Form
...to permanent scarring and loss of vision that may require corrective laser surgery or, if very severe, corneal transplantation. o Keratoconus: Some patients develop keratoconus, a degenerative corneal disease affecting vision that occurs in approximately 1/2000 in the general population. While there are several tests that suggest which patients might...
Apr 9, 2026
| Consent Form
...by the initial trauma or, after the initial trauma, by lid squeezing or eye rubbing · Loss of portions of the eye (cornea and sclera), which may require grafts or removal of the eyeball · Retinal tears and detachment, which may require laser treatments or additional surgery, or may be...
Apr 8, 2026
| Consent Form
...correction: use for toric IOL and relaxing incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Laser-assisted cataract surgery: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ You may want to create forms for astigmatism, presbyopia, or laser-assisted surgery that contain both the main...
Apr 8, 2026
| Consent Form
...IOL and relaxing incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Laser-assisted cataract surgery: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ · You may want to create forms for astigmatism, presbyopia, or laser-assisted surgery that contain both the main consent form and...
Apr 22, 2026
| Consent Form
...the patient’s eyesight and overall health. · [bookmark: _GoBack]Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of...
Apr 9, 2026
| Consent Form
...that lower the eye pressure with the fewest risks to the patient’s eyesight and overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or...
Aug 25, 2024
| Consent Form
...an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like an American style football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (Laser assisted in situ keratomileusis [LASIK] or Photorefractive...
Dec 1, 2025
| Consent Form
...Hylaform, Cosmoderm and Perlane. Aside from these treatments, additional options for the correction of lines and wrinkles do exist, including facial creams, BOTOX® Cosmetic (Botulinum Toxin Type A), chemical peels, and laser skin surface treatments, and surgery. Other options not mentioned here may exist. All options should be discussed with...
Apr 9, 2026
| Consent Form
...incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Femtosecond laser: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ These are sample consent forms. OMIC policyholders are not required to use it. Be sure to review it and modify it to suit your actual...
Apr 9, 2026
| Consent Form
...2 of 3 · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball...
Apr 21, 2026
| Consent Form
...separate visits because it would necessitate two periods of recovery from the laser surgery and might require additional time away from work. If the complication happens during surgery, your surgeon may need to perform another surgery right away to treat it. Your surgeon may discover a new condition or problem...
Apr 21, 2026
| Consent Form
...two periods of recovery from the laser surgery and might require additional time away from work. Cost: Professional and facility fees may be greater if the eyes are operated on different days, and the additional time off work can be costly. ____________ Initial Consent Statement: “I have read and understand...
Apr 23, 2026
| Consent Form
...list all risks and complications that may occur. The main risks and complications of [procedure/treatment]PRK are: PRK in eyes with more than 4 D of astigmatism: I understand that the FDA approval of the excimer laser for PRK was based on attempting to correct eyes with no more than 4...
Apr 8, 2026
| Consent Form
...and sometimes even the excimer laser in a procedure called PTK (phototherapeutic keratectomy). The cornea can be scraped if the lesions are superficial, or a deeper excision called a superficial keratectomy may be indicated · Mitomycin-C (MMC) maybe used during excision (removal) to minimize the recurrence of anterior basement corneal...
Apr 8, 2026
| Consent Form
...for eye drops, laser treatment, or another operation · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball or structures inside the eye such as the iris or the lens...
Apr 8, 2026
| Consent Form
...need for eye drops, laser treatment, or another operation · Worse or lost vision · Pressure that is too low · Damage to the eyeball or structures inside the eye such as the iris or the lens · Infection · The need for more surgery · Bleeding in the eye...
Apr 8, 2026
| Consent Form
...ophthalmologist cannot tell you about every risk. Here are some of the most common and serious risks: · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery · Worse...
Apr 8, 2026
| Consent Form
...performed. Your ophthalmologist cannot tell you about every risk. Here are some of the most common and serious risks: · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery...
Apr 8, 2026
| Consent Form
...Page 1 of 2 2 Page 3 of 3 · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · [bookmark: _GoBack]Pressure that is...
Apr 9, 2026
| Consent Form
...with the need for eye drops, laser treatment, another injection, or eye surgery · Worse or lost vision · Damage to the eyeball · Infection, soon after the injection, or months or years later · Inflammation · Cataract or clouding of the lens (except if you have already had cataract...
Apr 8, 2026
| Consent Form
...nueva afección o problema por primera vez durante la cirugía. Es posible que el cirujano deba cambiar el plan quirúrgico para tratar este problema o afección de inmediato. La oclusión permanente del punto lagrimal implica el uso de cauterización térmica (calor) o rayos láser para cerrar la abertura del conducto...
Dec 1, 2025
| Consent Form
...other surgery options. · There are other treatments and procedures to improve the appearance of lower eyelids. For instance, you could have Botox injections, filler injections, laser treatment, or a chemical peel. Talk with your ophthalmologist about these and other choices. As with all surgery, there are risks (problems that...
These are sample forms—download, review and revise as needed.