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LASIK Consent Form Mobile App

This is a consent form for LASIK eye surgery. This permanently corrects your vision and uses two lasers to do so. This consent form mobile app provides an overview of the procedure as well as the risks involved. It captures the patient's signature to ensure no misunderstandings. This app can be customized to meet your practices requirements.

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  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

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    Laser In-Situ Keratomileusis, or LASIK, is a permanent vision correction procedure.

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    The Food and Drug Administration (FDA) regulates the manufacture and use of the excimer laser in ...

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    This Consent Form and Patient Education generally describes the LASIK procedure and outlines cert...

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    A brief explanation of the eye may be of assistance in understanding the procedure.

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    Nearsightedness, or myopia: Myopia is caused either by an abnormally long eye or by a steep curva...

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    Farsightedness, or hyperopia: Farsightedness is caused by an abnormally short eye or by an excess...

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    Astigmatism: The cornea is not perfectly round but has different curvatures – it is shaped more l...

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    Presbyopia: Normally, when viewing a near object, the shape of the natural crystalline lens is al...

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    Vision problems resulting from refractive errors (myopia, hyperopia, and astigmatism) may be cor...

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    Laser In-situ Keratomileusis (LASIK) is available for treatment of mild to moderate amounts of my...

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    Photorefractive Keratectomy (PRK) is available for treatment of mild to moderate amounts of myopi...

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    INTACS is available for the treatment of mild amounts of myopia (1-3 diopters).

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    Refractive Lens Exchange is available for the treatment of moderate and high levels of myopia and...

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    Phakic Intraocular Lens Insertion is available for the treatment of moderate and high myopia.

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    Radial Keratotomy (RK) is available for the treatment of mild myopia and astigmatism.

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    Conductive Keratoplasty (CK) uses the controlled release of radio waves to correct mild hyperopia.

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    Contact lenses can change or distort the shape of the cornea.

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    An individual may not be an ideal candidate for LASIK if any of the following conditions exist:1.

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    During the pre-operative evaluation, a comprehensive evaluation of your eyes will be performed.

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    You will receive pre-medication with a drug such as Xanax.

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    The LASIK procedure typically takes approximately 5-10 minutes per eye.

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    Immediately after the procedure, your vision will be blurry and sensitive to light.

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    No vision correction procedure is without the risk of complications or side effects.

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    Vision Threatening and Other Complications: It is possible there could be loss of some, or all, o...

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    Corneal haze: The cornea may become cloudy due to inflammation or scarring.

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    1.

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    Visual aberrations such as glare, halos, and ghost images may occur from LASIK.

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    1.

  • ...and More!

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