Cataract Surgery Consent Form

Cataract surgery consent form is a document which is used by the patients who are willing to get their cataract surgery done by a certain surgeon. This form contains all the necessary information about the surgery and the patient’s consent for it. It is very important for the patient to read and understand all the information given in this form before signing it.

Time to complete

3 minutes

Eligibility

A cataract surgery consent form can be filled out by anyone who is considering or scheduled for cataract surgery.

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Questions for Cataract Surgery Consent Form

1.

Patient Name

The answer should be a text input.
2.

Address

The answer should be a text input.
3.

Phone Number

The answer should be a phone number.
4.

Date of Birth

The answer should be a date input.
5.

Referring Physician Name

The answer should be a text input.
6.

Social Security Number

The answer should be a text input.
7.

Driver's License Number

The answer should be a text input.
8.

I understand that cataract surgery is a procedure to remove the cloudy lens of my eye and replace it with a clear artificial lens.

The answer should be a single choice:
  1. Yes
  2. No
9.

I understand that I may have some discomfort after the surgery and that my eye may water or itch. I understand that my vision may be blurry for a short time after the surgery.

The answer should be a single choice:
  1. Yes
  2. No
10.

I understand that I will need to use eye drops for a few weeks after the surgery.

The answer should be a single choice:
  1. Yes
  2. No
11.

I understand that I will need to see my doctor for a follow-up visit a week or two after the surgery.

The answer should be a single choice:
  1. Yes
  2. No
12.

I understand that there are risks associated with any surgery, including infection, bleeding, and reactions to the anesthesia.

The answer should be a single choice:
  1. Yes
  2. No
13.

I have had the opportunity to ask the doctor any questions that I have about the surgery and I understand the risks, benefits, and alternatives to the surgery.

The answer should be a single choice:
  1. Yes
  2. No
14.

I hereby give my consent for the doctor to perform the cataract surgery on my eye/eyes.

The answer should be a single choice:
  1. Yes
  2. No
15.

Patient Signature

The answer should be a signature.
16.

Date

The answer should be a date input.

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Here are some FAQs and additional information
on
Cataract Surgery Consent Form

What is cataract surgery?

Cataract surgery is a type of surgery that is performed to remove cataracts from the eye. Cataracts are a condition that causes the lens of the eye to become cloudy and opaque, making it difficult to see. Cataract surgery involves making an incision in the eye and then removing the clouded lens. The surgery is usually performed under general anesthesia, which means that the patient is asleep during the procedure.

What are the risks of cataract surgery?

As with any surgery, there are always risks involved. Some of the risks associated with cataract surgery include infection, bleeding, and damage to the eye. In rare cases, cataract surgery can also lead to blindness.

What is the recovery time for cataract surgery?

Most people who have cataract surgery will be able to see better within a few days. However, it is important to note that the full

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