OD’s

As an added convenience to the independently practicing optometrists, we have provided a .pdf of the frequently used forms and patient instructions for surgery.

General Office Forms

• OD Referral Form (not for cataract referrals)
• Test Order Form B-Scan, Tear Lab, OPD, Allergy Testing, OCT
• New Patient Forms for Eye Care of Delaware
  • Forms for New Patient
  • Cataract Evaluation for New Patient
  • Financial Responsibility Policy
  • Notice of Privacy Practices

Cataract Surgery

• Cataract Surgery Pre-operative Work-up
• Cataract Post Op Form (Updated November 2020)
• Cataract Lifestyle Questionnaire
• History and Physical Form for Surgical Patient
• 90 Day Global Period Calculator
• Dry Eye Questionnaire
• OD Co-management Form Premium Lens