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 9, 2026
| Consent Form
...cause blurred vision, worsened or loss of vision, ocular pain, ocular surface irritation, sensitivity to light, delayed healing, scleral or corneal melt with perforation, scarring of the conjunctiva or cornea, iritis, glaucoma, cataract, and possible need for further eye surgery. If the complication happens during surgery, your surgeon may need...
Apr 8, 2026
| Consent Form
...a miniature telescope that is inserted into a corneal transplant and stitched into the patient’s own cornea. The natural lens, if still present, is removed. If the patient has already had cataract surgery, the lens implant is left alone. A soft contact lens is then placed onto the eye for...
Apr 22, 2026
| Consent Form
...that you have obtained informed consent. · Keep the original in the patient’s medical record. Version 10/06/2014 POTENTIAL COMPLICATIONS ASSOCIATED WITH PERIOCULAR REPOSITORY CORTICOSTEROID INJECTION(S) 1. Inadvertent injection into the choroidal or retinal circulation, emboli. 2. Perforation of the globe with permanent loss of vision/loss of eye. 3. Cataract. 4....
Apr 23, 2026
| Consent Form
...of the eye) · Damage to the lens (cataract) · Loss of vision or loss of the eye · Loss of peripheral (side) vision · Need for very thick glasses · Corneal clouding or scarring · Decrease or loss of vision caused by loss of circulation to the vital tissues...
Apr 24, 2026
| Consent Form
...vision may get worse. · Ozurdex injections can cause other eye problems such as: · an eye infection · glaucoma (high eye pressure) · cataracts (clouding of the eye’s lens) · detached retina (the light-sensitive part of the back of your eye might get pulled off) · [bookmark: _GoBack]hypotony (low...
Mar 9, 2023
| Consent Form
...of the eye’s lens (cataracts) · High eye pressure (glaucoma) · Low eye pressure (hypotony) · Damage to the cornea (clear covering of the front of the eye) · Bleeding in the eye (vitreous hemorrhage) · Bright redness in the white part of the eye · Eye irritation, inflammation, and...
Mar 28, 2022
| Consent Form
...(an immune response that can cause swelling, pain, or redness in the eye) detached retina (the light-sensitive part of the back of the eye pulls away from its normal position) cataracts (clouding of the eye’s lens) glaucoma (increased eye pressure) hypotony (reduced eye pressure) damage to the retina or cornea...
Mar 19, 2023
| Consent Form
...pre-injection preparation procedure, include, but are not limited to: Eye redness Eye pain Vision loss Cataract (clouding of the lens of the eye) Glaucoma (increased pressure in the eye) Hypotony (reduced pressure in the eye) Vitreous floaters Vitreous hemorrhage Inflammation or damage to the cornea or other parts of the...
May 9, 2023
| Consent Form
...eye pulls away from its normal position) Cataract (clouding of the lens of the eye) Glaucoma (increased pressure in the eye) [bookmark: _GoBack]Damage to the retina or cornea (the clear, protective layer in the front of the eye) Vitreous hemorrhage (bleeding inside the eye) Inflammation inside the eye that can...
Apr 22, 2026
| Consent Form
...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 vision loss, pain, or redness · Some patients taking this medication have...
Nov 10, 2023
| Consent Form
...some common and serious ones: IZERVAY™ will not improve your vision. Your vision may still get worse. Izervay 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...
Oct 25, 2023
| Consent Form
...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) Increases in intraocular (eye) pressure have been seen within 60 minutes of intravitreal injection, including with Eylea®HD...
Apr 9, 2026
| Consent Form
...and strokes. They increase the time it takes for you to stop bleeding. Patients who are having cataract surgery can usually keep taking these medications. Patients who are having eyelid, orbit, or retina surgery usually need to stop the medications before the surgery. Bleeding is a potential complication of any...
Apr 21, 2026
| Consent Form
...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 pressure) · Retina or cornea damage...
These are sample forms—download, review and revise as needed.