Please read carefully and sign your acceptance by entering your First and Last
Name in the boxes below.
CONSENT FOR MEDICAL TREATMENT
I hereby authorize and request that Lookout Eyecare provide such medical care and
such diagnostic and/or therapeutic procedures and treatments as in the judgment of
optometrist in attendance are deemed necessary and advisable.
DILATION & RETINAL IMAGING CONSENT
Lookout Eyecare is committed to offering ALL our patients the most thorough eye
examination available. This is performed through
and dilation. This allows the doctor to evaluate the internal parts of
the human eye and is part of our standard of
Advanced Retinal imaging is extremely important because it allows
the doctor to uncover and
document problems such as glaucoma, macular degeneration, hemorrhages, retinal
detachments, tumors, and other eye diseases much earlier than normally possible.
retinal imaging can reveal problems associated with systemic diseases such as
vascular disease, hypertension, and many others. This also provide a permanent
comparing future changes and could alleviate the need for dilation.
Dilation is always included in your complete eye exam. This
involves the use of eye drop
medications to widen your pupil. This allows the doctor to get a better view of
the health of the
eye - like an ocular health physical. Dilation can cause blurry near vision and
which may last approximately 4-6 hours. Most patients feel comfortable driving
home after, but
it is advised to set up a driver for your appointment in the case you need
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