Consent to Dilating Drops Form

Dear Patient,

In order to determine your candidacy for refractive eye surgery it is necessary to administer eye drops that will dilate your pupil.

Dilating drops are used to enlarge the pupils of the eye to allow the doctor to get a better view of the inside of your eye.

Dilating drops frequently blur vision for a length of time which varies from person to person (up to 48 hours) and may make bright lights bothersome as well affect your ability to operate a vehicle or read fine print. It is not possible for your doctor to predict how much your vision will be affected. Usually dilation is temporary, lasting several hours.

I hereby authorize Dr. Kranemann or such assistants designated by our doctor’s to administer dilating eye drops.

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