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Walter Reed National Military Medical CenterRefractive Surgery Consult Form This is an Active Duty Only Program Last Name: First Name: Rank: Age: DOB (MMDDYYYY): DOD ID: Home email: Work email:Unit:

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How to fill out refractive surgery consult form

1. To fill out a refractive surgery consult form, follow these steps:
2. Start by providing your personal information, such as your full name, contact details, and date of birth.
3. Next, provide information about your ocular history, including any past eye surgeries or eye conditions.
4. Specify your current vision correction method, such as glasses or contact lenses, and provide details about your prescription.
5. Answer questions about your overall health and any medications you are currently taking.
6. Provide details about your lifestyle and visual needs, including activities that require good vision, such as sports or driving.
7. Indicate any specific concerns or expectations you have regarding refractive surgery.
8. Finally, sign and date the consult form to confirm your consent and understanding of the information provided.

Who needs refractive surgery consult form?

1. Anyone who is considering refractive surgery, such as LASIK or PRK, needs to fill out a refractive surgery consult form.
2. This form is typically required by eye surgeons or ophthalmologists to gather essential information about the patient's ocular history, current vision correction methods, overall health, and visual needs.
3. It helps the healthcare professionals evaluate the patient's candidacy for the surgery and determine the most suitable treatment option.
4. By filling out the consult form, patients can ensure that their surgeon has all the necessary information to make informed decisions and provide appropriate care during the refractive surgery process.

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What is refractive surgery consult form?

Refractive surgery consult form is a document that must be completed by patients seeking refractive surgery to ensure that they understand the risks and benefits of the procedure.

Who is required to file refractive surgery consult form?

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

How to fill out refractive surgery consult form?

Patients must complete the form by providing their personal information, medical history, and acknowledging their understanding of the risks and benefits of refractive surgery.

What is the purpose of refractive surgery consult form?

The purpose of the consult form is to ensure that patients are well-informed about the potential risks and benefits of refractive surgery before making a decision.

What information must be reported on refractive surgery consult form?

The form must include the patient's personal information, medical history, any previous surgeries, current medications, and the patient's acknowledgment of the risks and benefits.