Fax to 855-598-6850 Pre-Operative Assessment - Furlong Vision-2026

1. Click ‘Get Form’ to open the Pre-Operative Assessment document in our platform.
2. Begin by filling out the Patient Information section. Enter your last name, first name, address, city, state, zip code, and contact numbers including evening and daytime phone as well as cell phone.
3. Provide your birthdate and age. Specify your eye color for additional context.
4. In the Medical & Ocular History section, list any medical conditions and previous ocular conditions such as surgeries or diseases. Include current medications and any known allergic reactions.
5. Complete the Procedure Assessment fields by entering visual acuity measurements and keratometry data. Ensure all values are accurate for optimal assessment.
6. Select the Recommended Procedure based on your needs and preferences. Add any comments or questions you may have in the designated area.
7. Finally, review all entries for accuracy before signing off with your optometrist's name and practice details.

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