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
18
resources.
Apr 24, 2026
| Consent Form
...obtained informed consent. · Keep the original in the patient’s medical record. Version 04/07/2007 [bookmark: _GoBack] IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLasetm Technology INDICATIONS AND PROCEDURE This information is being provided to you so that you can make an informed decision about IntraLASIK, or “all-laser” LASIK. Traditional...
Apr 22, 2026
| Consent Form
...for LASIK (Laser In Situ Keratomileusis) Retreatment By Lifting the Original Flap You have (nearsightedness, farsightedness, astigmatism) and your doctor, [Name, MD/DO], is recommending LASIK Retreatment by Lifting Original Flap. What is myopia, hyperopia, and astigmatism? · Remaining or induced myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. About LASIK Retreatment ·...
Apr 22, 2026
| Consent Form
...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 microkeratome...
Apr 21, 2026
| Consent Form
...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 the...
Apr 22, 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 clear...
Apr 23, 2026
| Consent Form
...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 to be...
Apr 22, 2026
| Consent Form
...2. The excimer laser can be used to correct low to moderate amounts of hyperopia (generally +1 to +5 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...
Apr 23, 2026
| Consent Form
...Then the exposed surface of the cornea is reshaped with an excimer laser, and the flap is returned to 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...
Apr 8, 2026
| Consent Form
...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. There...
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...
Apr 9, 2026
| Consent Form
...of being round like a basketball, the cornea is shaped like a football. This can 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...
Aug 25, 2024
| Consent Form
...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 keratectomy...
Apr 9, 2026
| Consent Form
...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 can...
Apr 24, 2026
| Consent Form
...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 remove...
Apr 8, 2026
| Consent Form
...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) of...
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
...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 RK,...
Apr 9, 2026
| Consent Form
...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 fat...
These are sample forms—download, review and revise as needed.