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CONTACT LENS FITTING AGREEMENT This agreement is between (patient) and New Vision Family Eyewear. You are about to be fitted with contact lenses at New Vision Family Eyewear. We will do our best to

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How to fill out contact lens patient agreement

01

Step 1: Start by reading the contact lens patient agreement form carefully.

02

Step 2: Fill out your personal information, such as name, address, date of birth, and contact information.

03

Step 3: Provide details about your eye prescription, including the type and power of contact lenses recommended by your eye doctor.

04

Step 4: Review and understand the terms and conditions stated in the agreement. This may include information about proper contact lens care, potential risks, and limitations.

05

Step 5: Sign and date the agreement to indicate your consent and agreement to abide by the terms mentioned.

06

Step 6: Make sure to retain a copy of the contact lens patient agreement for your records.

Who needs contact lens patient agreement?

01

Anyone who wishes to use contact lenses needs to fill out a contact lens patient agreement. This includes individuals who are new to wearing contact lenses, as well as those who have previously used them. The agreement helps ensure that the wearer understands the potential risks, responsibilities, and proper care instructions related to contact lens usage. Eye care professionals typically require patients to fill out this agreement before issuing contact lenses.

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What is contact lens patient agreement?

A contact lens patient agreement is a document that outlines the terms and conditions under which a patient can obtain and use contact lenses, ensuring that patients understand their responsibilities and the risks associated with contact lens wear.

Who is required to file contact lens patient agreement?

Eye care professionals and practices that provide contact lenses to patients are required to file the contact lens patient agreement.

How to fill out contact lens patient agreement?

To fill out a contact lens patient agreement, the eye care provider must provide the patient with the form, properly document patient information, confirm the prescription details, outline terms of use, and have the patient sign the agreement.

What is the purpose of contact lens patient agreement?

The purpose of the contact lens patient agreement is to inform patients about the proper use of contact lenses, the risks involved, and to document consent to the terms set by the eye care provider.

What information must be reported on contact lens patient agreement?

The information that must be reported on the contact lens patient agreement includes the patient's name, prescription details, instructions for lens care and use, potential risks, and the patient's acknowledgment and signature.

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