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Dilation, Refraction & CL Evil Patient Acknowledgement Regarding Precautions Following Dilation It may be necessary to dilate your eyes during the course of your eye examination or treatment. Dilating

How to fill out dilation refraction amp cl

1. Begin by gathering the necessary paperwork and materials for completing the dilation refraction and contact lens (CL) form. This may include your previous prescription, insurance information, and any specific instructions provided by your eye care professional.
2. Carefully read and understand each section of the form. Pay attention to any specific instructions or questions that need to be answered. It is important to provide accurate and detailed information to ensure a proper evaluation of your eyes and a correct prescription for contact lenses.
3. Start by filling out your personal information section. This typically includes your full name, date of birth, address, phone number, and email address. Double-check all the information to ensure accuracy.
4. Move on to the medical history section. This is an important part of the form as it helps the eye care professional identify any underlying health conditions or eye-related issues that may affect your prescription or suitability for contact lenses. Answer all the questions truthfully and to the best of your knowledge.
5. The next section usually pertains to your current eye health and any eye-related symptoms you may be experiencing. Here, you may need to provide information about any visual difficulties, eye pain, redness, dryness, or infections you have been experiencing. Be sure to describe your symptoms accurately and in detail.
6. If you wear glasses or contact lenses, you will be asked to provide your previous prescription details. This includes your current spectacle prescription and any previous contact lens specifications. Write down the information exactly as it appears on your previous prescription.
7. In some cases, the form may require you to describe any specific vision and eye-related goals you have, such as wanting to improve your distance vision, reduce the need for reading glasses, or address any particular eye concerns you may have. Provide as much detail as possible to help your eye care professional understand your needs and expectations.
8. Finally, sign and date the form to confirm that the information provided is accurate and complete. If there are any additional forms or documents to be submitted along with the dilation refraction and CL form, make sure to gather and attach them accordingly.

Who needs dilation refraction and CL?

1. Individuals who wear contact lenses or are interested in trying them for the first time.
2. Those seeking a new prescription for contact lenses to improve their vision.
3. People experiencing changes in their vision who require a comprehensive eye examination.
4. Individuals with certain eye conditions or diseases that require regular monitoring, such as glaucoma, keratoconus, or dry eye syndrome.
5. Those who want to ensure optimal eye health and early detection of any potential eye problems.

Remember, it is always recommended to consult with an eye care professional to guide you through the process of filling out the dilation refraction and CL form accurately and to address any specific concerns or questions you may have.

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