CATARACT SURGERY QUALITY ASSURANCE: 4-6 Week Post-op Report

In an effort to track our results, please fax the information below.


To:
Patient:
DOB:
Date of Surgery:
Date of Exam:
Examining Doctor:

Right Eye

Refraction: ×   20  /
Left Eye

Refraction: ×   20  /
How do you rate this patient's satisfaction
with their refractive error outcome?






Comments:

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655 Medical Center Dr NE       |       Salem, Oregon 97301       |     503.581.5287       |         Fax 503.386.1377       |       mceyeclinic.com