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
87
resources.
Apr 9, 2026
| Consent Form
...applying specific patterns of ultraviolet (UV) light to the IOL to change its shape, which results in changes to the refractive correction of your vision. The UV light is delivered with the RxSight Light Delivery Device (LDD), either by your surgeon or by an optometrist. The number of light adjustment...
Apr 9, 2026
| Consent Form
...or surgery center as verification that you have obtained informed consent. · Keep the original in the patient’s medical record. Version 05/23/23 [Your Letterhead] Consent for Comanagement after RxSight Light Adjustable Lens (RxLAL™) Cataract Surgery Patient Name: ____________________________ Date of Birth: ___________ Patient Confirmation I understand that my ophthalmologist, Dr....
Jun 2, 2025
| Consent Form
Sep 14, 2026
| Consent Form
...of the smaller appearance of images (“minification”) and slight decrease in peripheral vision caused by the thickness of the lenses. 2. Contact Lens. While contact lenses provide higher quality and more normal vision, they have a slight risk of complications, especially if they are worn overnight. The risks of contact...
Sep 11, 2026
| Consent Form
...glare, a “starbursting” or halo effect around lights, or other low-light vision problems that may interfere with the ability to drive at night or see well in dim light. Although there are several possible causes for these difficulties, the risk may be increased in patients with large pupils or high...
Sep 15, 2026
| Consent Form
...may become worse in dim light or fog. It may also cause some visual side effects such as rings or circles around lights at night. It may be difficult to distinguish an object from a dark background, which will be more noticeable in areas with less light. Driving at night...
Sep 14, 2026
| Consent Form
...images, light sensitivity, and tearing. Possible long-term complications of PRK surgery: o Haze: Loss of perfect clarity of the cornea, usually not affecting vision, which usually resolves over time. o Starbursting. After refractive surgery, a certain number of patients experience glare, a “starbursting” or halo effect around lights, or...
Sep 14, 2026
| Consent Form
...some or all of the time. 4. After refractive surgery, a certain number of patients experience glare, a “starbursting” or halo effect around lights, or other low-light vision problems that may interfere with the ability to drive at night or see well in dim light. The exact cause of these...
Sep 14, 2026
| Consent Form
...the tear duct openings in the eyelid. 5. After refractive surgery, a certain number of patients experience glare, a “starbursting” or halo effect around lights, or other low-light vision problems that may interfere with the ability to drive at night or see well in dim light. The exact cause of...
Sep 16, 2026
| Consent Form
...traffic laws. · Increased sensitivity to light or night glare. At night there may be a “starbursting” or halo effect around lights. The risk of this side effect may be related to the size of the pupil, and larger pupils may put one at increased risk. · An overcorrection or...
Nov 10, 2023
| Consent Form
...you notice any of these problems after the injection, such as: Signs of infection, which include eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. New or large floaters that do not go away. Flashing lights or decreased...
Sep 10, 2026
| Consent Form
...a special ultra-violet (UV) light on your eye for another 30 minutes and keep adding drops. The vitamin eye drops and UV light work together to make the collagen stronger. The cornea becomes stiffer and usually stops bulging out. The goal of CXL is to stop the cornea from getting...
Apr 22, 2026
| Consent Form
...extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. • New or large floaters that do not go away. • Flashing lights or decreased side vision with the floaters. You can help prevent or reduce these problems. Do not rub your eyes or go...
Apr 9, 2026
| Consent Form
...any other problems after laser Capsulotomy, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters....
Sep 11, 2026
| Consent Form
...away if you notice any other problems after Laser Suture Lysis, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased...
Sep 10, 2026
| Consent Form
...useful vision. 4. I may experience incapacitating light sensitivity from sunlight or other bright light sources for a varying length of time, or possibly permanently. 5. I may experience incapacitating glare or halos from oncoming headlights or other bright light sources, particularly in the evening or nighttime, for a varying...
Apr 22, 2026
| Consent Form
...ophthalmologist right away if you notice any other problems after ILUVIEN implant , such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights...
Apr 22, 2026
| Consent Form
...a Lucentis injection, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow...
Apr 23, 2026
| Consent Form
...decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. · New or large floaters that do not go away. · Flashing lights or decreased side vision with the floaters. You can help prevent or reduce these problems. Do not rub your eyes...
Apr 23, 2026
| Consent Form
...a Triesence injections, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow...
Apr 9, 2026
| Consent Form
...extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent or reduce the above problems by...
Sep 10, 2026
| Consent Form
...A corneal transplant is a type of eye surgery to replace your damaged cornea with a cornea from a human donor. The cornea is the clear, outer layer of your eye. It helps focus light and is needed to see. There are 3 main layers in the cornea. Here is...
Sep 10, 2026
| Consent Form
...to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent or reduce the above problems by doing the...
Sep 11, 2026
| Consent Form
...away if you notice any other problems after Laser Iridoplasty surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased...
Sep 11, 2026
| Consent Form
...surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions:...
May 9, 2023
| Consent Form
...Tell your ophthalmologist right away if you notice any other problems after the injection, such as: Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. New or large floaters that do not go away. Flashing lights or decreased...
Apr 8, 2026
| Consent Form
...dystrophy including the nodules may grow back. You may need additional treatment or surgery to treat these complications. · In addition to the usual complications of corneal excision, MMC may cause blurred vision, worsened or loss of vision, ocular pain, ocular surface irritation, sensitivity to light, delayed healing, scleral or...
Sep 15, 2026
| Consent Form
...if you notice any other problems after retina laser surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side...
Mar 19, 2023
| Consent Form
...the injection, such as: New or large floaters that do not go away. Flashing lights or having less side vision with the floaters. Signs of infection, which include eye pain, blurry or decreased vision, being extra sensitive to light, eye redness, and pus or other discharge coming from the eye....
Mar 19, 2023
| Consent Form
...or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent or reduce the...
Apr 21, 2026
| Consent Form
...ophthalmologist right away if you notice any other problems after an Avastin injection such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights...
Apr 21, 2026
| Consent Form
...after [procedure/treatment], such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these...
Sep 10, 2026
| Consent Form
...is not practiced. 13. Skin Hypopigmentation – Hypopigmentation (lightening of the skin), which occurs because of laser-induced injury to the melanocytes (pigment containing cells in the skin) and which can be permanent. Possible Long-term Complications of CO2 Laser Skin Resurfacing Surgery: 1. Increased susceptibility to sun – Because of the...
Oct 31, 2024
| Consent Form
...retinal detachment). Rhegmatogenous retinal detachment is a tear and separation of one of the layers in the back of the eye that senses light (retina). Call your healthcare provider or go to the emergency room right away if you see flashing lights, see a curtain or veil covering part of...
Apr 23, 2026
| Consent Form
...blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent or reduce...
Sep 10, 2026
| Consent Form
...right away if you notice any other problems after Anterior Chamber Paracentesis , such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights...
Sep 11, 2026
| Consent Form
...after Goniosynechialysis surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow...
Apr 8, 2026
| Consent Form
...other problems after MIGS, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must...
Apr 9, 2026
| Consent Form
...[Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help...
Sep 11, 2026
| Consent Form
...or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent or reduce the...
Sep 14, 2026
| Consent Form
...such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You...
Sep 11, 2026
| Consent Form
...after Intacs®, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these...
Apr 23, 2026
| Consent Form
...you notice any other problems after Vitrectomy surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with...
Sep 10, 2026
| Consent Form
...Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions: You can help prevent...
Apr 23, 2026
| Consent Form
...after Retisert such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these...
Aug 25, 2024
| Consent Form
...from normal aging, from an eye injury, various medical conditions or if you have taken certain medications such as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the...
Sep 14, 2026
| Consent Form
...notice any other problems after [procedure/treatment], such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters....
Apr 8, 2026
| Consent Form
...surgery such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters. You must follow these instructions:...
Sep 10, 2026
| Consent Form
...surgeon may need to change the plan for surgery to treat this problem or condition right away. Instructions Tell your ophthalmologist right away if you notice any other problems after Anterior Chamber Reformation, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus...
Sep 10, 2026
| Consent Form
...other problems after Bleb revision surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming from the eye. [Example:] New or large floaters that do not go away. [Example:] Flashing lights or decreased side vision with the floaters....
These are sample forms—download, review and revise as needed.