New Vision Eye Clinic

Eye correction laser care
 

• Avoid getting non-sterile water from shower, hair washing, etc. into your eyes during the first few days after surgery.
• Have more resting time after laser.
• Be careful when you’re in the shower or bath. Be sure to keep soap out of your eye when you wash your hair, and watch out for hair spray and shaving lotion.
• Don’t rub your eyes for at least 3 months.
• Don't drive cars or ride scooters until you feel comfortable and your vision stability.
• Wear the eye shield while you sleep for 1-2 weeks.
• Avoid pools, spa, hot spring and beaches for at least 3 months.
• No eye makeup for at least a week.
• No strenuous exercise for two weeks.
• Your eyes will likely be sensitive to light for a while. Dark sunglasses are helpful.
• Avoid dirty and dusty environments for at least 1 week.

 
1.         Intended Surgery (If the medical terms are unclear, please provide brief
    explanations).
(1)     Type of illness：
(2)     Suggested operation：
(3)     Reasons for suggested operation：
2.         Doctor’s Statements
(1)     I have, to the best of my ability, fully informed the patient about the surgery, especially the following matters:
·Reasons for suggested surgery, surgical process and scope, risks and success rate, and the possibility of blood loss
·Possible complications and treatments for the complications
Consequences of not operating and alternative treatments
·Short-term or long-term conditions that might be expected after the surgery
·I have provided written information concerning the surgery (if available) to the patient
(2)     I have given the patient sufficient time to ask questions regarding the surgery and answered them as such:
I.               ﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍                                                                            
II.        ﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍                                                                            
III.     ﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍﹍                                                                             
  
 
Signature of chief operating surgeon:                                       
Date: __________________ 
Time: __________________  
3.         Patient’s Statements
·The doctor has explained and I understand the necessity, process, risks, success
                     rate, and other information regarding the operation.
·The doctor has explained and I understand the risk of choosing other possible
                     treatments.
·The doctor has explained and I understand the possible situations that might
                     occur after the surgery and the risks of not undergoing surgery.
·I understand there might be blood loss at crucial times. I□consent □do not
                    consent   to a blood transfusion.
·I have been able to communicate my questions and misgivings regarding my
                    situation, the surgical process, and treatment method, etc., to the doctor and have
                     received adequate explanation.
·I understand that during the surgical process, if it is necessary to remove certain
                    organs or tissues to aid with treatment, the hospital will preserve it for a duration of
                    time to study and judiciously dispose of at a later date.
·I understand that, as of right now, this surgery is the best possible choice, but that
                    there is no guarantee that it will improve the condition of my illness.
 
          
In accordance with all agreements above, I give my consent to this surgery.        
                                           

Signature for Consent: _____________________      Relation: Patient’s: __________________
Address:_____________________________________    Telephone number: ______________
Date: _____________________________   
 Time: ____________________________
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Witness: _____________________________            Signature: _________________________
Date: _____________________________              
 Time: ____________________________