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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 60 resources.
Nov 23, 2016 | Consent Form
...other surgery options. · There are other treatments and procedures to improve the appearance of lower eyelids. For instance, you could have Botox injections, filler injections, laser treatment, or a chemical peel. Talk with your ophthalmologist about these and other choices. As with all surgery, there are risks (problems that...
Mar 19, 2023 | Consent Form
...use these medications “off-label” because they may be similar or even have a better effect compared to an FDA-approved medication. Your ophthalmologist will let you know if other medications, or a similar medication with a different method of delivery, are available for your condition; whether laser or other types of...
Oct 9, 2014 | Consent Form
...separate visits because it would necessitate two periods of recovery from the laser surgery and might require additional time away from work. If the complication happens during surgery, your surgeon may need to perform another surgery right away to treat it. Your surgeon may discover a new condition or problem...
Oct 9, 2014 | Consent Form
...two periods of recovery from the laser surgery and might require additional time away from work. Cost: Professional and facility fees may be greater if the eyes are operated on different days, and the additional time off work can be costly. ____________ Initial Consent Statement: “I have read and understand...
Oct 3, 2014 | Consent Form
...or Phototherapeutic Keratectomy (PTK) performed with the excimer laser. COMPLICATIONS AND SIDE EFFECTS There is no guarantee that the surgery will improve your condition. It may fail to improve your vision or even make it worse. In addition, surgery is risky. Sometimes it can make the original problem worse, cause...
Oct 6, 2014 | Consent Form
...injections, including no treatment, collagen for lip or other facial soft tissue augmentation, and cosmetics, Botox, laser skin resurfacing, chemical peels, or plastic surgery for wrinkle reduction. Results. I understand that the actual degree of improvement cannot be predicted or guaranteed. Furthermore, I understand that the effect will gradually wear...
Oct 9, 2014 | Consent Form
...each eye treated at separate visits because it would necessitate two periods of recovery from the laser surgery and might require additional time away from work. Cost: Professional and facility fees may be greater if the eyes are operated on different days and the additional time off work can be...
Oct 9, 2014 | Consent Form
...an elective procedure. · The alternatives to KeraVision Intacs for correcting nearsightedness include eyeglasses, contact lenses, and other kinds of refractive surgery procedures such as Radial Keratotomy (RK), Photorefractive Keratectomy (PRK) and Laser in situ keratomileusis (LASIK). · KeraVision Intacs will not prevent the development of naturally occurring eye problems...
Oct 9, 2014 | Consent Form
...total corneal thickness 250 um · Scrape off the epithelium · Perform mild excimer laser phototherapeutic keratectomy to smooth the corneal bed · Apply MMC 0.02% formulation (same as the 0.2mg/mL solution) · Application protocol · Cut out 6 mm disc of filter paper with a trephine · Moisten disk...
Mar 13, 2020 | Consent Form
...treat diabetic macular edema. Talk with your eye surgeon about the risks and benefits of these medications. · Laser surgery to treat leaking blood vessels in the eye that might be causing the swelling. Risks (problems this medication may cause). There are risks with the medication, the injection, and the...

These are sample forms—download, review and revise as needed.