OD Referral Forms and Maps

Patient Care Referral Form
Bellaire Map
Pasadena Map
Clear Lake Map
Sugar Land Map
Katy Map
Woodlands Map
All Locations

Necessary Forms for LASIK Patients

Informed Consent for Lasik Patients
LASIK – Post Op Drops Form
LASIK Post Op Form
LASIK Post-Op Instructions for Patients
LASIK Pre-Op Report
Lifetime Limited Warranty

Refractive Surgery Forms (LASIK)

LASIK Mono Vision Policies
Pregnancy Nursing Disclosure
The WaveScan WavePrint System
LASIK Pre-Op Patient Instructions
Near Vision
Driver’s License Changes After LASIK
EVO Visian ICL vs Other Procedures

Refractive Surgery Forms (PRK)

PRK Post-Op-Drops

New Patient Forms

HIPAA – English
HIPAA – Spanish
Lifestyle Vision Questionnaire – English
Lifestyle Vision Questionnaire – Spanish
Medical History Form
Medical History Spanish
Visual Assessment Questionnaire – Right
Visual Assessment Questionnaire – Left
Visual Assessment Questionnaire Spanish
Welcome Letter
Billing Policy

Disease of the Eyes – Patient Handouts

Adenoviral Eye Infection
Cataract, What Is It
Diabetic Patient and Eye Disease
Macular Degeneration Prevention Guide… Vitamins
Retina Holes, Tears and Retina Detachment
Trabeculectomy, What Is It
YAG Laser Capsulotomy
Yag Laser Peripheal Iridotomy or YAG


Cataract 1 Day Post Op
Cataract 1 Week Post Op Forms
Cataract Post Op Check List for OD
Cataract Post-Op Instructions
Cataract PreOp Sx Instructions
Custom Intraocular Lens Lifetime Warranty
General Follow Up Exam Form for Patient’s Chart
Informed Consent for Cataract Patient
Generic vs Brand Cataract Drops
Before and After Cataract Instructions and Drops
LenSx Laser Patient Education Brochure


Bleph – Disclosure and Informed Consent for Medical
Bleph Post Op Home Instructions
Lid Scrub Hygiene – English
Lid Scrub Hygiene – Spanish
Medical Necessity for Upper Bleph


Glaucoma Consultation Form
Glaucoma SLT Laser Information – Patient Handout
Informed Consent for SLT for Glaucoma – English
Informed Consent for SLT for Glaucoma – Spanish

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