Risk Management


Consent Forms in Spanish

Together, OMIC, the American Academy of Ophthalmology (AAO) and Pan-American Association of Ophthalmology (PAAO), provide the following Informed Consent documents in Spanish with support from the Bruce E. Spivey Fund for Risk Management Studies.

Questions? Suggestions? Contact us: riskmanagement@omic.com.

For consent forms in English, please visit the Consent Forms page.

Anesthesia (1)

General Anesthesia

Cataract (4)

Cataract (and/or Implantation of Intraocular Lens) Consent Form

Cataract: Same Day Sequential Bilateral Surgery Addendum Consent

Femtosecond Laser Addendum

YAG Posterior Capsulotomy

Cornea (5)

DSEK Corneal Transplant Surgery

Keratoprosthesis (Artificial Corneal Transplant) Consent

Penetrating Keratoplasty (PK) Corneal Transplant Consent Form

Permanent Punctal Occlusion Consent Form

Pterygium Consent Form

Drugs and Devices (1)

Dilating Eye Drops Consent Form

Emergency Room (1)

Refusal of Recommended Medical or Surgical Treatment

Glaucoma (5)

Addendum: Argon Laser Trabeculoplasty

Glaucoma Filtering Surgery (Trabeculectomy) and Use of Anti-Metabolites

Glaucoma Surgery: Ciliary Body Glaucoma Treatments

Glaucoma: Laser Iridotomy or Iridectomy

iStent Trabecular Micro-Bypass Stent Surgery Consent Form

Neuro (0)
Oculofacial Plastic Surgery (11)

Blepharoplasty (Eyelid Tuck or Lift) Consent Form

Botox Use Consent Form

Chalazion: Incision and Drainage of Chalazion Consent Form

CO2 Laser Skin Resurfacing Consent Form

Dacryocystorhinostomy (DCR) Consent Form

GentleMAX Laser Treatment Consent Form

Juvederm Consent Form

Latisse™ Treatment Consent Form

Ptosis Surgery Consent Form

Punctal Plugs Consent Form (Courtesy of Bernard H. Chang, MD, a practicing ophthalmologist in Nashville, TN.)

Tumescent Liposuction Surgery Consent Form

Pediatric (3)

Anti-VEGF injection for ROP

Laser for ROP

Strabismus Surgery Consent Form

Retina (12)

Avastin™ (bevacizumab)

Eylea (afibercept) Consent

Fluorescein Angiography Consent Form

Jetrea® (ocriplasmin) Consent

Lucentis™ (ranibizumab) Consent

Macugen™ Consent Form

Ozurdex™(dexamethasone) Consent

Periocular Repository Corticosteriod Injections

Photodynamic Therapy with Visudyne® Consent Form

Retisert™ Consent form

Triamcinolone Acetonide (Kenalog™ Triesence™ Trivaris™) Consent Form

Vitrectomy Surgery Consent

Refractive (18)

AK Consent Form

Comanagement after Eye Surgery

Conductive Keratoplasty (CK) for Hyperopia

Conductive Keratoplasty NearVisionSM CK

Conductive Keratoplasty: Bilateral Simultaneous CK for Hyeropia

Intacs: Consent for Off-Label Therapeutic Use for Post-LASIK Ectasia

Intacs. Bilateral Simultaneous Intacs for Treatment of Myopia

Intacs™ by Keravision® for Myopia

LASIK Consent Form

LASIK Retreatment Consent

LASIK: Bilateral Simultaneous Surgery

LASIK: IntraLASIK Consent Form

Phakic Implant Verisyse™ Informed Consent

PRK Consent Form

PRK. "Off-label"

Refractive Lens Exchange (RLE)

Visian ICL™ Phakic Implant Surgery

Wavefront Addendum

Patient (3)

Comanagement after Eye Surgery

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Covered Benefit" (Sample Letter)

Informed Choice to Not Undergo Recommended Treatment or Procedure "Not Medically Necessary" (Sample Letter)

Practice (0)
Surgery (7)

*General Consent for Medical and Surgical Procedures (use with addendums)

Cornea Surgery (Addendum to General Consent)

Glaucoma Surgery Consent (Addendum to General Consent)

Laser Surgery Consent (Addendum to General Consent)

Orbital and Plastic Surgery Consent (Addendum to General Consent)

Retina Surgery Consent (Addendum to General Consent)

Strabismus Surgery Consent (Addendum to General Consent Form)



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OMIC is the largest insurer of ophthalmologists in the United States and we've been the only physician-owned carrier to continuously offer coverage in all states since 1987 (pending in WI). Our fully portable policy can be taken with you wherever you practice. Should you move to a new state or territory, you're covered without the cost or headache of applying for new coverage.

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