Patient Forms

Laser vision correction patients, please fill out the following forms before your initial evaluation:

• Patient Registration Forms
• LASIK Consultation Form
• Notice of Privacy Practice
• Deposit Letter

Glaucoma, pediatric, and general optometry or ophthalmology patients, please fill out the following forms before your initial appointment:

• Patient Registration Forms
• Financial Responsibilites
• Notice of Privacy Practices
• Pediatric shapes Form

Consent forms for surgery:

• LASIK
• PRK
• Cataract
• Visian
• Intacs
• PTK
• Corneal transplant
• Pterygium
• Pediatric

Post-operative instructions for surgery:

• LASIK
• PRK
• Cataract
• Visian
• Intacs
• PTK
• Corneal transplant
• Pterygium

Cornea Handouts

• Corneal Abrasion and Erosion
• Corneal Disease and Corneal Transplants
• Corneal Ulcer
• Fuchs Corneal Dystrophy
• Herpes Simplex Eye Disease
• Herpes Zoster
• Keratoconus

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Medical Records

To obtain a copy of your medical records*, please download the following release form for the correct location.

• Release Form – Chevy Chase
• Release Form – Washington D.C.

The form may be sent via e-mail or fax to:

Medical Records Requests
medicalrecords@edow.com
Fax: 301-215-4144

* There will be a charge for a copy of your medical record – refer to the form for pricing. Please allow two weeks time for processing.