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
22
resources.
Sep 11, 2026
| Consent Form
...This information is being provided to you so that you can make an informed decision about IntraLASIK, or “all-laser” LASIK. Traditional LASIK surgery involves two procedures: first, a microkeratome blade is used to create a flap on the cornea to expose the underlying tissue. After the flap is created, an...
Sep 14, 2026
| Consent Form
...· This is an elective procedure. You do not have to have LASIK Retreatment. Benefits How will LASIK Retreatment treat my vision and/or condition [How can this medication help]? · The goal of repeat LASIK is to achieve the best visual result with the safest method while dramatically reducing dependency...
Sep 14, 2026
| Consent Form
...Informed Consent for Laser In-Situ Keratomileusis (LASIK) You have [Condition], and your doctor, [Name, MD/DO], is recommending LASIK. What is [Condition]? · [State the condition and how it impacts the patient.] About LASIK LASIK is one of a number of alternatives for correcting nearsightedness, farsightedness and astigmatism. In LASIK, the...
Sep 11, 2026
| Consent Form
...[Name, MD/DO], is recommending Bilateral Simultaneous LASIK. What is nearsightedness, farsightedness, astigmatism? · Vision acuity deficits About Bilateral LASIK · In LASIK, the microkeratome is used to shave the cornea to create a flap. The flap then is opened like the page of a book to expose tissue just below...
Sep 11, 2026
| Consent Form
...· Keep the original in the patient’s medical record. Version 4/2026 [Your Letterhead] Informed Consent for Therapeutic Use of Intacs® for Post-LASIK Ectasia You have ectasia and your doctor, [Name, MD/DO], is recommending Intacs® for Post-LASIK Ectasia. What is Ectasia? Ectasia is an abnormal bulging forward of the cornea, the...
Sep 10, 2026
| Consent Form
51637 [Su Encabezado] Aceptación de la Atención Postoperatoria de LASIK Entiendo que (nombre del consultorio/médico) tratará la condición actual de mi(s) ojo(s) secundaria a un procedimiento de cirugía refractiva previa, realizado por un cirujano en un centro que no estaba asociado con (nombre del consultorio/médico). (Nombre del consultorio/médico) me informó...
Sep 14, 2026
| Consent Form
51784 This form is intended as a sample. It does not constitute the standard of care nor does it provide legal advice. It contains the information OMIC recommends the surgeon personally discuss with the patient. How to use this sample · Please modify it to fit your practice. · Delete...
Sep 14, 2026
| Consent Form
...-1 D to -12 D). 2. LASIK is a two-phae operation. First, a thin layer of cornea is either surgically cut with the microkeratome or a flap is created using a laser. The exposed surface of the cornea is then reshaped with an excimer laser, and the flap is returned...
Sep 16, 2026
| Consent Form
...its original position. LASIK has been found to be quite successful and relatively safe for the correction of moderate and high myopia up to -12 D. Above 12 diopters, LASIK is known to have a high incidence of complications involving the quality of vision, especially at night, and has proven...
Sep 15, 2026
| Consent Form
...D or diopters) and low to higher amounts of myopia (generally -1 D to –12D) through either PRK (photorefractive keratectomy) or LASIK (laser in situ keratomileusis). LASIK is an operation which combines the creation of a flap with the microkeratome or a laser and the removal of tissue with the...
Apr 9, 2026
| Consent Form
...make your vision blurry. Astigmatism can be reduced by a toric IOL, glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI) that can be done at the same time as the cataract operation, or as a separate procedure. A...
Apr 8, 2026
| Consent Form
...baseball). With astigmatism, the eye is long (like a football). Many people with cataracts have astigmatism. If you have astigmatism, wearing glasses or contact lenses can help you see more clearly. Or you could have surgery (called LASIK or PRK) to change the shape of your eye to correct astigmatism....
Sep 10, 2026
| Consent Form
...starts after eye surgery such as LASIK (post-refractive ectasia). Corneal cross-linking (CXL) can help make the middle layer stronger. CXL is an eye treatment that may be done in your ophthalmologist’s (eye surgeon’s) office. There are 3 steps. 1) Your ophthalmologist will numb your eye with drops and then gently...
Sep 14, 2026
| Consent Form
...There are several reasons why you may need a new cornea: · Complications from LASIK or PRK surgery · Degenerative eye conditions called corneal dystrophies which affect the clarity of the cornea. · Scarring from previous infections, such bacterial, fungal, and viral (e.g. Herpes simplex) infections. · Excessive swelling (edema)...
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: ·...
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...
Apr 9, 2026
| Consent Form
...of being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI), which...
Sep 10, 2026
| Consent Form
...alternatives are there for my condition (choices and options)? AK is not the only option. Your other treatment choices may include: Eyeglasses, contact lenses, and other refractive surgical procedures such as PRK or LASIK. · No treatment. [Describe consequences of refusing the surgery or treatment, e.g.:] “If you decide not...
Apr 9, 2026
| Consent Form
...of being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI), which...
Apr 8, 2026
| Consent Form
...your refraction) by changing the shape of the cornea, the clear front of the eye. The FS laser uses suction. If you have had a type of refractive surgery called LASIK, the suction could open up or move the flap. If you have had other refractive surgeries called AK or...
Sep 10, 2026
| Consent Form
...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 may decide to do nothing. Excess skin, muscle, and...
Sep 11, 2026
| Consent Form
...incluyen la cirugía refractiva (LASIK, QFR o QC). El implante Kamra es otro tipo de cirugía que puede elegir. El implante KAMRA es un disco de plástico redondo que se coloca dentro de uno de sus ojos. Es más pequeño y delgado que un lente de contacto. El cirujano ocular...
These are sample forms—download, review and revise as needed.