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Refractive Surgery Assessment & Referral Form PLEASE PRINT or TYPE Assessment Date (m×d/y): Patient Name (Dr.×Mr.×Mrs.×Ms.×Miss): Sex: M Female M Male DOB (m×d/y): Address: City: Prov×State:
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How to fill out refractive surgery assessment amp:

01
Begin by gathering all the necessary information, such as personal details, medical history, and current eye condition.
02
Carefully read through each section of the assessment form, paying attention to any specific instructions or guidelines provided.
03
Provide accurate information about your eye health, including any previous surgeries or treatments you have undergone.
04
Answer all the questions honestly and to the best of your knowledge, as this will help the healthcare professional assess your suitability for refractive surgery.
05
If you are unsure about any question or require further clarification, don't hesitate to seek assistance from a healthcare provider or the clinic providing the assessment.
06
Double-check your responses before submitting the form to ensure accuracy and completeness.

Who needs refractive surgery assessment amp:

01
Individuals who have been experiencing vision problems such as nearsightedness, farsightedness, or astigmatism and wish to explore corrective surgical options may need a refractive surgery assessment.
02
People who are considering undergoing refractive surgery as a means to lessen or eliminate their reliance on glasses or contact lenses may also require this assessment.
03
Patients with stable eye conditions, who meet certain age and health criteria, may be suitable candidates for refractive surgery and would need to undergo this assessment to determine their eligibility.
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Refractions surgery assessment amp is a form that is used to evaluate a patient's suitability for refractive surgery procedures.
Ophthalmologists, optometrists, or other healthcare professionals who are considering performing refractive surgery on a patient.
The form should be filled out accurately with the patient's detailed medical history, eye measurements, and any other relevant information.
The purpose of the assessment form is to ensure that the patient is a good candidate for refractive surgery and that the procedure is safe to perform.
The form should include the patient's medical history, eye measurements, current eye prescription, and any past eye surgeries.
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