Cataract lens priorities and quotation record

For a cataract consultation. Not a lens recommendation, clinical suitability test or price quote.

Priorities

Eye(s) discussed: ____
Activities and viewing distances that matter: ____
Tasks for which I accept glasses: ____
Questions about visual quality: ____

Proposed optical plan

Exact lens model and category: ____
Target focus for each eye: ____
Astigmatism correction proposed: ____
Expected glasses need: ____
Trade-offs explained for my eyes: ____
Other eye conditions affecting benefit: ____

Proposed service

Assessment/tests: ____
Surgeon/facility/anesthesia: ____
Lens and any separately priced feature: ____
Surgical technique and separately priced feature: ____
Follow-up included: ____
Unknown charges: ____

After the discussion

What is confirmed? ____
What is still a choice? ____
Questions or reports outstanding: ____
Who answers them and how? ____
Instructions/urgent contact supplied by treating team: ____

Original organizational template, not a medical test. All free decision records · Related reading paths