Cataract/Lensectomy Post-Op Form

Use the following form to submit reports on Cataract/Lensectomy procedures. The submitted form will be automatically sent to the Braverman Eye Center. You will also be able to print a copy for your records after submitting your form.

*Please complete all applicable form fields:





Select if patient did not show up for scheduled appointment
Left message for patient to reschedule
Unable to contact patient

PRE-OP Rx:





OD Intended Procedure Outcome: (leave blank if none)


OS Intended Procedure Outcome: (leave blank if none)


Post-Op Information:


 

20/

20/


20/

 
 
x
==> 20/

 
 
x
==> 20/












mm. Hg.

mm. Hg.



Dissatisfaction Issues

Nighttime Halos/Glare
Glare/Light Sensitivity





RV:
 
With BEC
With Co-care provider