Read this booklet as many times as you’d like. If you have additional questions, list them on a separate paper to discuss with our doctors. When you are ready, complete this booklet by following these five steps:

1. Write your initials on the short highlighted lines at the bottom of each page. 

2. On the second to last page, under the heading Patient Treatment Statement, we have indicated our plan for you by highlighting the boxes that apply to your treatment. If you agree with our plan, check the highlighted boxes. 

3. Below these highlighted boxes, print your name, print the date, and then sign. 

4. On the last page, under the heading Patient Statement of Informed Consent, leave the sections marked Patient Signature and Date at the bottom blank. You will sign this when you arrive in our office. 

5. Don’t make any other marks on the rest of the booklet. Email [email protected] to confirm once you have completed the five steps above.

This booklet, completed prior to arrival + your eyedrops in hand = your ticket to our office on surgery day!