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:
  • VA:   20/
  • VA:  20/
  • Post-Op Information:
  • 20 /
    20 /
    20 /

  •     x     ==> 20/

  •     x     ==> 20/
  • OD SL Exam:
  • OS SL Exam:
  • TaG:
  •  mm. Hg.        OS mm. Hg.
  • Retina:
  •        OS
  • Alert Issues - (If present, must include in alert issue comments below)
  • Dissatisfaction Issues
    Nighttime Halos/Glare
    Glare/Light Sensitivity

  • RV:        With BEC     With Co-care provider

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