Cataract/Lensectomy Pre-Op Form

Use the following form to submit reports on Pre-Op 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 the form.

Please complete all applicable form fields:

  • PRE-OP Rx:
  • VA:   20/
  • VA:   20/
  • OD Intended Procedure Outcome: (leave blank if none)
  •   AIM 
  • OS Intended Procedure Outcome: (leave blank if none)
  •   AIM 



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