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REFRACTIVE SURGERY CONSULTATION FORM (Circle one) LAST CK Name: Date: Address: City: State: Zip: Home Phone No.: Work Phone No.: Other (cell): Emergency name/number: Home Email Address: Age: DOB:

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What is refractive surgery consultation form?

Refractive surgery consultation form is a document used to gather information about a patient's eye health and determine if they are a good candidate for refractive surgery.

Who is required to file refractive surgery consultation form?

Patients who are considering undergoing refractive surgery are required to file the consultation form.

How to fill out refractive surgery consultation form?

The form can be filled out by providing accurate information about the patient's medical history, current eye health, and any previous eye surgeries.

What is the purpose of refractive surgery consultation form?

The purpose of the form is to assess the patient's eligibility for refractive surgery and to ensure that they understand the risks and benefits of the procedure.

What information must be reported on refractive surgery consultation form?

Information such as the patient's medical history, current eye prescription, any previous eye surgeries, and any medications or allergies must be reported on the form.

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