LETTER TO A PATIENT EXAMINED AND FITTED FOR CONTACT LENSES WHO
HAS REQUESTED A COPY OF THE PRESCRIPTION

(Physician’s Letterhead)

(date)

Dear   (Patient):

In compliance with the Fairness to Contact Lens Consumers Act, I am providing you with a copy of your contact lens prescription [Or I am providing a copy of – or verifying – your prescription for contact lenses to ____________.] Your prescription for contact lenses is based on an initial examination and contact lens fitting [and follow-up examination, if applicable]. It is important that you understand that continued follow-up exams are necessary to your eye health. Lens design modifications may be needed and it may be necessary to change your prescription.

In addition, there are eye conditions that may keep you from wearing contact lenses. These conditions may only be discovered during follow-up exams. Some of the conditions that might keep you from wearing contact lenses are: frequent eye infections; severe allergies; and dry eye (improper tear film). An ophthalmologist is the physician specialist who can diagnose and treat conditions that may prevent optimal contact lens wear.

There are also certain environmental conditions or personal practices revealed during follow-up exams that may prevent you from wearing contact lenses, such as: a work environment that is very dusty or dirty or your improper handling and care of the lenses. An important aspect of contact lens wear is learning how to properly wear the lenses and how to disinfect and clean them. Even if you have worn contact lenses before, I believe it is important for my office to evaluate or reevaluate your proper handling and care of the lenses. We can also advise you regarding the use of appropriate cosmetics. Improper use of cosmetics can lead to eye irritation as well as infection.

Please contact my office if you would like to schedule a follow-up appointment. The health of your eyes is our main concern and should be yours.

Sincerely,

						, M.D.