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Refractive Surgery Consult Forman Active Duty Only Program DEC 2017Section 1. Last Name: First Name: Rank: Age: DOB (MMDDYYYY): DOD ID: Home email: Work email:Unit: Unit Zip: Work Tel: Mobile Tel:
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How to fill out refractive surgery consult form

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How to fill out refractive surgery consult form

01
To fill out a refractive surgery consult form, follow these steps:
02
Start by providing your personal information such as your name, age, and contact details.
03
Next, indicate your reason for seeking refractive surgery and specify any previous eye surgeries or treatments you have undergone.
04
Provide your medical history, including any existing eye conditions, allergies, and medications you are currently taking.
05
Mention any vision problems you are experiencing and describe their frequency and severity.
06
Include information about your occupation and daily activities that may impact your vision requirements.
07
Indicate your preferred method of refractive surgery, such as LASIK, PRK, or intraocular lenses.
08
Provide details about your current eyeglass or contact lens prescription, if applicable.
09
Mention any expectations or concerns you may have regarding the surgery or its outcomes.
10
Finally, sign and date the form, acknowledging that the information provided is accurate to the best of your knowledge.

Who needs refractive surgery consult form?

01
Refractive surgery consult forms are needed by individuals who are considering undergoing refractive surgery procedures.
02
These forms help eye care professionals gather relevant information about the patient's eye health, medical history, and visual needs.
03
By filling out the consult form, patients provide valuable insights that aid in determining their suitability for refractive surgery and selecting the most appropriate procedure.
04
Whether someone is seeking to correct nearsightedness, farsightedness, or astigmatism, a refractive surgery consult form is an essential tool in evaluating their candidacy for the procedure.
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Refraction surgery consult form is a document that patients need to fill out before undergoing refractive surgery.
Patients who are planning to undergo refractive surgery are required to file the consult form.
Patients need to provide their personal information, medical history, and consent for the surgery on the consult form.
The purpose of the form is to ensure that patients are fully informed about the risks and benefits of the surgery.
The form should include the patient's name, contact information, medical history, current medications, and any known allergies.
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