Dilation Consent Form
Consent for pupil dilation during comprehensive eye exam.
- 7 days free
- Cancel any time
- 10 languages
- No patient data stored on our servers
- Fields
- 6
- Practice type
- Optometry
- Category
- Consent Forms
- Languages
- English
- Editable
- Yes — add, remove and reword fields
- Sharing
- Print, PDF or a secure link
Dilation Consent Form — preview
Sample layout generated from the actual template.
Pupil dilation allows for a more thorough exam of the retina and optic nerve. After dilation, vision may be blurry and light-sensitive for several hours.
Free to start — your edits are saved as you go.
About this form
The dilation consent form is a consent forms document used by optometry practices. Consent for pupil dilation during comprehensive eye exam. In BoomCloud Forms it is a starting point: every field, heading and statement can be edited before you share it with patients.
Practices may use this template as a starting point and should review the wording against their own professional, regulatory and legal requirements before use.
What's included
This template ships with 6 fields:
- Patient Name — Text
- I consent to pupil dilation today — Single choice
- I will arrange transportation if needed — Single choice
- Signature — Signature
- Date — Date
When practices use it
Optometry teams typically attach this form to the treatment workflow, completing it with the patient after the procedure and its alternatives have been discussed. It can be sent digitally ahead of the visit, completed on a tablet in the office, or printed as a PDF.
How to customize it
- Reword any question, add fields, or remove ones your practice doesn't need.
- Apply your practice name, logo and colors so the form matches your brand.
- Switch to another supported language where a translated version exists.
- Share a secure link with the patient, or download a print-ready PDF.