Get Laser Vision Retreatment Evaluation Form

Completing the Laser Vision Retreatment Evaluation Form is a vital step in assessing your eligibility for retreatment. This guide provides clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to complete the evaluation form successfully.

1. Press the ‘Get Form’ button to access the evaluation form and open it in your preferred editor.
2. Begin by entering the patient information. Fill in the patient's name, date of birth, and phone number in the designated fields. Ensure that all information is accurate and up-to-date.
3. Next, provide the referring doctor’s information. Fill in the referring doctor's name, phone number, practice name, fax number, and email address.
4. Now, complete the patient refractive and eye health information section. Enter the best uncorrected visual acuity (VA) for each eye (OD for right eye, OS for left eye, and OU for both). Specify any refraction and keratometric readings as required.
5. Provide the intraocular pressure (IOP) readings, selecting the appropriate methods used for measurement. Circle the method performed and fill in the measurements for both eyes.
6. Include any remarkable findings from the slit lamp examination (SLE) and dilated fundus examination (DFE) in the designated fields. If there are other notable observations, record them in the provided section.
7. Finally, ensure that all required fields are completed. Once done, you can save your changes, download a copy of the completed form, print it for physical submission, or share it as necessary via email or fax to patientcare@lasikplus.com or 513-792-5637.

Complete your Laser Vision Retreatment Evaluation Form online today to facilitate your retreatment process.