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Refractive Surgery Consultation Request Form REASON FOR CONSULTATION OF LAST PARK ICL OS OD Other: ___Physician Requested Dr. Mark Tontos Dr. Jason Crockery Dr. Christopher Stream Referring DOCTOR

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How to fill out new facility refractive surgery

01

Schedule initial consultation with an ophthalmologist or refractive surgeon

02

Discuss your medical history, current eye health, and vision goals

03

Undergo a comprehensive eye exam to evaluate your candidacy for refractive surgery

04

Choose the type of refractive surgery that best suits your needs and preferences

05

Get pre-operative testing done to ensure you are ready for the procedure

06

Follow all pre-operative instructions provided by the medical team

07

Attend the surgery appointment and follow post-operative care guidelines for optimal results

Who needs new facility refractive surgery?

01

Individuals with refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism

02

People who want to reduce or eliminate their dependence on prescription glasses or contact lenses

03

Patients who have stable vision and realistic expectations about the outcomes of refractive surgery

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What is new facility refractive surgery?

New facility refractive surgery refers to the process of performing surgical procedures, such as LASIK or PRK, to correct vision refractive errors in a newly established medical facility.

Who is required to file new facility refractive surgery?

Any medical facility that offers refractive surgery services and is newly established.

How to fill out new facility refractive surgery?

The new facility refractive surgery form must be completed with all relevant information regarding the medical facility and the services provided.

What is the purpose of new facility refractive surgery?

The purpose of new facility refractive surgery is to ensure that newly established medical facilities offering refractive surgery services are in compliance with regulations and standards.

What information must be reported on new facility refractive surgery?

Information such as the name and address of the medical facility, types of refractive surgery procedures offered, and qualifications of the medical staff must be reported.

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