
V110615 Office Use Only: Patent ID# LASER VISION RETREATMENT EVALUATION FORM Referring Doctors: Please fill out the Patient Refractive / Eye Health information below and/or send a copy of your comprehensive.
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How to fill out the Laser Vision Retreatment Evaluation Form online
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.
- Press the ‘Get Form’ button to access the evaluation form and open it in your preferred editor.
- 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.
- Next, provide the referring doctor’s information. Fill in the referring doctor's name, phone number, practice name, fax number, and email address.
- 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.
- 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.
- 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.
- 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.
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What does TLC Lasik stand for?
Patients are automatically enrolled in the TLC Lifetime Commitment program upon completion of laser vision correction treatment if you meet eligibility guidelines. Patients must sign a TLC Lifetime Commitment Acknowledgment on the day of surgery, stating they understand the conditions of the program.
How long after LASIK will I need a touch up?
In general, vision is not stable after LASIK for 3 months, and for this reason, enhancements are typically performed after this time period. Sometimes, after several years, a patient experiences a change in their nearsightedness, farsightedness, or astigmatism.
Is LASIK surgery a lifetime guarantee?
The “lifetime” guarantee is for the surgery center, not your lifetime. If your LASIK surgeon closes down their surgery eye center, your guarantee is useless. You may need to have your annual eye examinations with an affiliated doctor's office.
Can you get a touch up for LASIK?
A LASIK touch up or LASIK enhancement is a follow up procedure done with the goal of further sharpening your vision if you're not happy with the initial LASIK results or if your vision has changed over time. LASIK can be a permanent solution for living without glasses or contacts.
How many times can you have a LASIK touch up?
Generally speaking, there isn't a limit to how many times you can get LASIK surgery during your lifetime, but that doesn't mean that you're a good candidate for an enhancement. The main driving factor in whether or not you can continue to get LASIK is how thick your cornea is.
Is Lasik touch up free?
Cost of a LASIK Enhancement That's why LASIK surgeons should include a free enhancement within the first year of your original laser eye surgery procedure. Your eye doctor will look for refractive errors in your post-operative appointment. Years after your original LASIK surgery, your improved vision will cost extra.
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