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Chart Forms


LASIK Lifestyle Checklist
LASIK Lifestyle Checklist

Personality style and adaptability are key in determining a patient’s emotional suitability for LASIK.

LASIK Lifestyle ChecklistMore Details
Have the patient complete this one-page questionnaire before the consultation begins so your technician can uncover potential issues as testing proceeds.

Fully editable, available for immediate download. Customize with your own practice logo.


Price: $10.00
LASIK/ASA Consultation Form
LASIK/ASA Consultation Form

A LASIK Consultation requires a different mindset and charting protocol than a standard comprehensive eye exam.

LASIK/ASA Consultation FormMore Details
Use these three forms in the initial one-hour LASIK consultation without dilation to ensure all key testing has been performed and patient motivation uncovered.

Includes 3 forms:
- Consultation Form
- Patient Medical History
- Comment Form

All are fully editable and available for immediate download. Customize with your practice logo.


Price: $49.00
LASIK/ASA Measurements Form
LASIK/ASA Measurements Form

During a dilated exam, use this comprehensive eye history and medical evaluation form to assess eye health and suitability for LASIK and/or ASA.

LASIK/ASA Measurements FormMore Details
Fully editable. Available for immediate download. Customize with your practice logo.


Price: $29.00
LASIK Surgery Planning Excel Template
LASIK Surgery Planning Excel Template

Capture all pre-operative data in one easy-to-reference form and ensure your surgery planning is thorough and complete.

LASIK Surgery Planning Excel TemplateMore Details
This planning template allows for comparison of treatments between lasers or between traditional and custom platforms and selection of appropriate nomogram adjustment.

Includes 3 spreadsheets:
- Data input sheet
- OD Surgery Plan
- OS Surgery Plan

Fully editable, available for immediate download.


Price: $99.00
Monovision Fit
Monovision Fit

Accurate monovision fits are a must for any practice delivering patient-preferred vision.

Monovision FitMore Details
Use this form to ensure patients are fit properly for their lens trial so that vision is demonstrated prior to surgical correction.

Fully editable. Available for immediate download. Customize with your practice logo.


Price: $29.00
LASIK Post-Op Form
LASIK Post-Op Form

Capturing consistent, accurate post-operative data is a must to accurately track LASIK outcomes.

LASIK Post-Op FormMore Details
This Post-Op Form ensures you have the required data to measure acuities, refractions, complications and satisfaction consistently for each patient. Two patient visits per form.

Fully editable. Available for immediate download.


Price: $29.00
ASA Post-Op Form
ASA Post-Op Form

Capturing consistent, accurate post-operative data is a must to accurately track ASA outcomes.

ASA Post-Op FormMore Details
This Post-Op Form ensures you have the required data to measure acuities, refractions, complications and satisfaction consistently for each patient. Space allowed for pressure checks and drop regimen adjustment. Two patient visits per form.

Fully editable. Available for immediate download.


Price: $29.00