OD Portal

OD Referral Forms and Maps

Referral Form Front Side
Referral Form Back Side w:maps
Bellaire Map
Pasadena Map
Clear Lake Map
Sugar Land Map
Katy Map
Woodlands Map

Necessary Forms for LASIK Patients

informed-consent-for-lasik-patients(178 KB)
LASIK – Post Op Drops English/Spanish Form (461 KB)
LASIK Post Op Form
LASIK Post-Op Instructions for Patients(44 KB)
LASIK Pre-Op Report (30.67 KB)
Lifetime_Limited_Warranty(56.5 KB)

Refractive Surgery Forms (LASIK)

Consent Form Cornea Flap Lift
LASIK Enhancement Informed Consent
informed-consent-for-lasik-patients
Lifetime_Limited_Warranty
Medical History Form
LASIK Mono Vision Policies
LASIK Post-Op Drops/English/Spanish
LASIK Post Op Form
LASIK Postoperative Patient Management
Pregnancy Nursing Disclosure
LASIK Pre OP Instructions
The WaveScan WavePrint System
LASIK Immediate Post-Operative Exam
LASIK Pre-Procedure Exam Report
LASIK Pre-Op Patient Instructions
Near_Vision
Driver’s License Changes After LASIK
Visian ICL vs Other Procedures

Refractive Surgery Forms (PRK)
PRK Informed Consent
PRK Enhancement Informed Consent
PRK Post-Op-Drops English-Spanish

New Patient Forms

Referral Form Front Side
Referral Form Back Side w:maps
HIPAA – English(38.5 KB)
HIPAA – Spanish
Lifestyle Vision Questionnaire – English(61.48 KB)
Lifestyle Vision Questionnaire – Spanish
Bellaire Map(430.04 KB)
Clear Lake Map (437.25 KB)
Katy Map
Pasadena Map (436.55 KB)
Sugar Land Map434.79 KB)
Woodlands Map
Medical History Form(46.66 KB)
Medical History Spanish (16.42 KB)
Referral Form Front Side(194 KB)
Visual Assessment Questionnaire English
Visual Assessment Questionnaire Spanish
Welcome_Letter_(16.46 KB)

Disease of the Eyes – Patient Handouts

Adenoviral Eye Infection
Cataract, What Is It_
Cornea Transplant, What Is It? pdf
Diabetic Patient and Eye Disease
Macular Degeneration Prevention Guide… Vitamins (1.19 MB)
Pterygium Photo (2.91 KB)
Retina Holes, Tears and Retina Detachment(254.5 KB)
Trabeculectomy, What Is It_
Vitamin and Mineral Supplements For Your Eyes
YAG Laser Capsulotomy
Yag Laser Peripheal Iridotomy or YAG

Cataract

Cataract 1 Day Post Op (201.5 KB)
Cataract 1 Week Post Op Forms (210 KB)
Cataract Post Op Check List for OD
Cataract Post-Op Instructions (266 KB)
Cataract PreOp Sx Instructions (286.5 KB)
Custom Intraocular Lens Lifetime Warranty (81.93 KB)
General Follow Up Exam Form for Patient’s Chart (45.5 KB)
Informed Consent for Cataract Patient (275 KB)
Generic vs Brand Cataract Drops (155 KB)
Before and After Cataract Instructions and Drops

After Cataract Drop Schedule

ReSTOR Patient Awareness Brochure

Simulated Vision – Toric Lens

LenSx Laser Patient Education Brochure

Blepharoplasty

Bleph – Disclosure and Informed Consent for Medical (216.5 KB)
Bleph Post Op Home Instructions (237 KB)
Lid Scrub Hygiene – English (269.5 KB)
Lid Scrub Hygiene – Spanish (250.5 KB)
Medical Necessity for Upper Bleph (37.5 KB)

Procedural Information

Minor Surgical Procedure Informed Consent (251.5 KB)
Obtaining a Medical History on Your Patient (30 KB)
PDT/Visudyne Procedure w/Wet orNeovasticular (282.5 KB)
Standard Treatment Protocols (281 KB)
Visual Assessment (29.5 KB)

Intacs

Informed Consent for Intacs Surgery for Kerato-Eng (325 KB)
Informed Consent for Intacs Surgery for Kerato-Spa (324 KB)
Intacs Candidates – Are You One? (167 KB)
Intacs Post Operative Instructions (293.5 KB)
Intacs Pre Operative Instructions for the Intacs S (285.5 KB)
Intacts – CLEK Study Information Handout (524.48 KB)

Glaucoma

Glaucoma Consultation Form(281 KB)
Glaucoma Patient’s Trabeculectomy Pre Op Orders (281 KB)
Glaucoma SLT Laser Information – Patient Handout (255 KB)
Informed Consent for SLT for Glaucoma – English (262.5 KB)
Informed Consent for SLT for Glaucoma – Spanish (284.5 KB)

Latisse and Botox

Botox Cosmetic Questions and Answers (44.5 KB)
Botox Injection Informed Consent (60 KB)
Latisse Evaluation Form (68.1 KB)
Latisse Patient Brochure (743.62 KB)
Love the Long Eyelashes Article – New York Times (92.62 KB)
Patient Guide – How to Use Latisse (85.5 KB)

Our Locations

Houston

6565 W. Loop S. Suite 650

Bellaire, TX 77401

Medical Office: 713-797-1010

Medical Fax: 713-357-7276

LASIK/ReSTOR: 713-395-1515

LASIK/ReSTOR Fax: 713-357-7278

Pasadena

4415 Crenshaw Road

Pasadena, TX 77504

Medical Office: 281-977-8800

Medical Fax: 281-977-8877

Sugar Land

15400 S.W. Freeway, Suite 301

Sugar Land, TX 77478

Medical Office: 281-277-1010

Medical Fax: 281-277-4504

Clear Lake

450 W. Medical Center Blvd., #305

Webster, TX 77598

Medical Office: 281-332-1397

Medical Fax: 281-338-1215

Katy

Kingsland Medical Plaza 777 S. Fry Road Suite 102

Katy, TX 77450

Medical Office: 713-797-1010

Medical Fax: 713-357-7276

The Woodlands/Conroe

690 South Loop 336 West, Suite 205 (The building is 1mile West of I-45, just after Medical Center Blvd)

Conroe, TX 77304

Medical Office: 713-797-1010

Medical Fax: 713-357-7276