Get the free Contact Lens Agreement Form (5.27.24) - Google Docs
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Contact Lens Agreement FormName: ___ Date of Birth: ___ In consideration of the fitting and supplying of contact lenses byCambridge Optometry, I, the undersigned, agree to the following terms and conditions: 1. C ontact Lens Fitting and Examination:I understandthat the evaluation and fitting of contact lenses require additional procedures beyond a routine eye examination. I agree to undergo these additional procedures as recommended by the optometrist
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How to fill out contact lens agreement form
How to fill out contact lens agreement form
01
Start by entering your personal information at the top of the form, including your name, address, and contact details.
02
Provide information about your eye care professional, such as their name and practice location.
03
Fill in your medical history, including any eye-related conditions, surgeries, or allergies.
04
Indicate the type of contact lenses you will be using and any specific prescription details.
05
Review the agreement terms, including responsibilities and risks associated with contact lens wear.
06
Sign and date the form to confirm your understanding and agreement to the terms.
Who needs contact lens agreement form?
01
Anyone who wishes to obtain contact lenses must fill out a contact lens agreement form.
02
Individuals who have a prescription for contact lenses from an eye care professional.
03
Patients who want to ensure they understand the proper care and usage of their contact lenses.
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What is contact lens agreement form?
A contact lens agreement form is a legal document that outlines the terms and conditions under which a patient may obtain contact lenses from an eye care professional, ensuring that the patient understands their responsibilities and the usage of the lenses.
Who is required to file contact lens agreement form?
Patients who wish to purchase contact lenses, as well as eye care professionals or retailers providing these lenses, are typically required to file the contact lens agreement form.
How to fill out contact lens agreement form?
To fill out a contact lens agreement form, patients should provide their personal information, including their name and contact details, along with specific details regarding their contact lens prescription, preferences, and any necessary agreements or acknowledgments required by the eye care provider.
What is the purpose of contact lens agreement form?
The purpose of the contact lens agreement form is to ensure that patients are aware of the proper usage, care, and limitations of contact lenses, while also protecting the eye care provider by confirming the patient's acknowledgment of these terms.
What information must be reported on contact lens agreement form?
The information that must be reported on the contact lens agreement form includes the patient's personal information, contact lens prescription details, instructions for use and care of the lenses, potential risks and side effects, and the patient's acknowledgment and consent.
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