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