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 22, 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 10, 2026
| Consent Form
...any other problems after Glaucoma 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...
Sep 10, 2026
| Consent Form
...plan for surgery to treat this problem or condition right away. Instructions Tell your ophthalmologist right away if you notice any other problems after Canaloplasty 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....
Sep 10, 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
...you notice any other problems after of Express Shunt 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...
Sep 11, 2026
| Consent Form
...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 doing...
Sep 11, 2026
| Consent Form
...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 above problems...
Sep 11, 2026
| Consent Form
...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 following:...
Sep 11, 2026
| Consent Form
...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 Laser Trabeculoplasty surgery, such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus or other discharge coming...
Sep 16, 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 16, 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 16, 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 16, 2026
| Consent Form
...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 or...
Apr 8, 2026
| Consent Form
...correction, 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:...
Apr 8, 2026
| Consent Form
...if you notice any other problems after astigmatism correction, 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...
Apr 24, 2026
| Consent Form
...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 following:...
Apr 22, 2026
| Consent Form
...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 swimming...
Oct 25, 2023
| Consent Form
...after 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...
Sep 11, 2026
| Consent Form
...are some: fatigue, nausea, vomiting, headache, upset stomach, light-headedness, fainting, hives, and itching. A few patients have had severe allergic reactions (anaphylaxis) or bronchospasm (which causes breathing difficulties) after FA. These conditions can be life threatening. Be sure to tell your ophthalmologist about allergies to food, dyes, or medications, and...
Sep 14, 2026
| Consent Form
...causing decreased vision from direct blocking of the visual axis, leading to severe irregular astigmatism · Pyergium can be blinding condition, especially in sub-tropical and tropical climates, if work outside, or are in bright sunlight · Pterygium treatment · Excise the lesion · Perform a conjunctival-limbal autograft · Recurrence rate...
Jul 14, 2026
| Consent Form
...· Facial asymmetry (one side looks different than the other) · Temporary weakness of a nearby muscle leading to droopy eyelid, double vision, difficult whistling, or drinking from a straw · Generalized weakness · Flu-like syndrome or respiratory infection · Nausea, headache, lightheadedness · Allergic reaction to the botulinum toxin...
Sep 14, 2026
| Consent Form
...Eye infection · Eye or eyelid pain · Eyelid irritation (redness, burning, tearing, itching, discharge, foreign body sensation) · Changes in your vision · Sensitivity to light · Stye (a red, sore lump near the edge of the eyelid) · Swelling of the eyelid glands · Scratch on the front...
Sep 10, 2026
| Consent Form
...view of the inside of your eye. Dilating drops frequently blur vision for a length of time which varies from person to person and may make bright lights bothersome. It is not possible for your ophthalmologist to predict how much your vision will be affected. Because driving may be difficult...
Sep 11, 2026
| Consent Form
...if the patient wishes but most do very well with light sedation. Risks of anesthesia include but are not limited to damage to the eye and surrounding tissue and structures, loss of vision, breathing problems, and, in extremely rare circumstances, stroke or death. PATIENT’S ACCEPTANCE OF RISKS · I understand...
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...
Sep 14, 2026
| Consent Form
...right away if you notice any other problems after PTK, 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...
Apr 22, 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...
Jan 7, 2025
| Consent Form
...surgery. The 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 [procedure/treatment], such as: [Example:] Eye pain, blurry or decreased vision, extra sensitivity to light, eye redness, and pus...
Sep 14, 2026
| Consent Form
...you notice any other problems after MMC, 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...
Sep 16, 2026
| Consent Form
...may experience temporary hyper-pigmentation (darkening) that usually fades after several months. Some patients may have a genetic predisposition for persistent discoloration at the incision sites. Patients that have experienced hyper-pigmentation, or hypo-pigmentation (pale or light-colored scars) in the past might expect to also experience it with these incisions. Certain areas...
Sep 14, 2026
| Consent Form
...may 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...
Sep 11, 2026
| Consent Form
...needle placed into a vein in your arm or pills taken before surgery. Deeper anesthesia can be provided if the patient wishes but most do very well with light sedation. Risks of anesthesia include but are not limited to damage to the eye and surrounding tissue and structures, loss of...
Dec 1, 2025
| Consent Form
...a needle placed into a vein in your arm or pills taken before surgery. Deeper anesthesia can be provided if the patient wishes but most do very well with light sedation. Risks of anesthesia include but are not limited to damage to the eye and surrounding tissue and structures, loss...
Sep 15, 2026
| Consent Form
...verification that you have obtained informed consent. 1. Keep the original in the patient’s medical record. Version 11/9/2016 INFORMED CONSENT FOR SKIN CANCER SURGERY REPAIR (Repair of defect after skin cancer removal) WHY MIGHT I NEED SURGERY AFTER SKIN CANCER REMOVAL? Skin cancer in light-skinned people is relatively common. In...
Sep 15, 2026
| Consent Form
...under the skin, bruising, redness, itching, pain, tenderness, or slight swelling. · Injections into the lip area could trigger a recurrence of facial cold sores (Herpes simplex infections) for patients with a history of prior cold sores. Precautions and contraindications If the complication happens during surgery, your surgeon may need...
Apr 21, 2026
| Consent Form
...the 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...
Mar 19, 2023
| Consent Form
...problems after the injection, such as: · 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. You must follow these instructions: • Do not rub your eyes or go swimming for 3...
These are sample forms—download, review and revise as needed.