Permanent Punctal Occlusion Consent Form

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The permanent punctal occlusion consent form was provided by OMIC Claims and Risk Management Committee member Steven I. Rosenfeld, MD, FACS. Dr. Rosenfeld is a board-certified, fellowship-trained ophthalmologist who specializes in medical and surgical treatments of corneal conditions, infectious and inflammatory eye diseases, and all forms of laser vision correction. Dr. Rosenfeld practices with Delray Eye Associates, PA in Delray Beach, Florida.

This form is intended as a sample form. It contains information OMIC recommends you as the surgeon personally discuss with the patient. Please review it and modify to fit your actual practice.

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Publicly-traded insurance companies exist to make profits for shareholders while physician-owned carriers often return profits to their policyholders. Don’t underestimate this benefit; it can add up to tens of thousands of dollars over the course of your career. OMIC has one of the most generous dividend programs for ophthalmologists and has returned more than $90 Million to our members through dividends.