Get the free REFRACTIVE SURGERY PATIENT QUESTIONNAIRE

Are you allergic to any medications Y / N -If yes please list 2. Have you ever taken or are you currently taking Acutane or 3. Do you have a pacemaker 6. Do you have any history of circle any that apply - asthma/eczema - autoimmune disease - high blood pressure - heart problems - HIV/AIDS - diabetes - hepatitis - other EYE HISTORY How old were you when you first started wearing glasses Any eye disorders circle any that apply - glaucoma high eye pressure -dry eye syndrome - any eye injury -...

How to fill out refractive surgery patient questionnaire

How to fill out a refractive surgery patient questionnaire:

1. Read the instructions carefully: Begin by thoroughly reviewing the instructions provided with the questionnaire. Understand the purpose of each section and the information being sought.
2. Provide accurate personal information: Start by providing your personal information accurately. This typically includes your full name, date of birth, address, and contact details. Double-check for any errors before moving on to the next section.
3. Medical history: The questionnaire will likely ask for your medical history, including any past surgeries or eye conditions. Provide complete and accurate information about any previous eye-related problems or procedures you have undergone.
4. Current medications: Note down any prescription or over-the-counter medications you are currently taking. This information is important for the surgeon to understand potential interactions or complications related to the surgery.
5. Allergies and sensitivities: Disclose any known allergies or sensitivities you may have, especially those related to medications or anesthesia. This information will assist in determining the appropriate treatment plan and avoid any adverse reactions.
6. Lifestyle and vision requirements: The questionnaire may inquire about your lifestyle and specific vision requirements. Be thorough in describing daily activities, hobbies, or sports that may influence the recommended procedure. This will help the surgeon tailor the surgery to your individual needs.
7. Expectations and concerns: Include your expectations and any concerns you may have regarding the surgery. Openly communicate any fears or anxieties you might be experiencing. This information will enable the surgeon to address your concerns and ensure realistic expectations are set.
8. Contact information for emergency situations: The questionnaire may ask for emergency contact information. Provide the name and phone number of a person who can be reached in case of any unforeseen circumstances or complications during or after the surgery.

Who needs refractive surgery patient questionnaire?

People who are considering or scheduled for a refractive surgery procedure may need to fill out the refractive surgery patient questionnaire. This questionnaire helps gather valuable information about their medical history, current medications, lifestyle, expectations, and concerns. By collecting this information, the surgeon can assess the patient's suitability for the procedure, customize the surgery if necessary, and ensure they receive the best possible care and outcome.

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What is refractive surgery patient questionnaire?

The refractive surgery patient questionnaire is a form that collects information about a patient's medical history, current medications, and eye health to determine if they are a suitable candidate for refractive surgery.

Who is required to file refractive surgery patient questionnaire?

Patients who are interested in undergoing refractive surgery are required to fill out the refractive surgery patient questionnaire.

How to fill out refractive surgery patient questionnaire?

Patients can fill out the refractive surgery patient questionnaire by providing accurate information about their medical history, current medications, and eye health either online or in person at the clinic.

What is the purpose of refractive surgery patient questionnaire?

The purpose of the refractive surgery patient questionnaire is to assess if a patient is a suitable candidate for refractive surgery based on their medical history and eye health.

What information must be reported on refractive surgery patient questionnaire?

The refractive surgery patient questionnaire must include information about the patient's medical history, current medications, and eye health, including any past eye surgeries or conditions.