Supporting you in best practice myopia management
This informed consent form for myopia management is a template resource supplied by Myopia Profile to support you in developing your own consent form. It is provided as a MS word document for you to edit, add and omit content as you require. It is pre-formatted for you to print immediately on plain paper, or to copy over for printing onto your own practice letterhead paper. You could also save it as a PDF to email to patients, and/or use the text on your practice website.
Myopia Profile retains no copyright over this content to allow your preferred edits. This template resource is currently only available in English.
This template is designed to provide you comprehensive, parent-suitable information, with scientific references. You can then tailor this to your needs (for example, treatment availability) and print it onto plain paper or on your own practice letterhead paper. The informed consent form includes short text sections in lay person language on the following topics.
- What is myopia?
- Why is myopia a concern?
- Why manage myopia in children? (Short-term and long-term benefits are described)
- Treatments for slowing myopia progression. (An overview of treatment type, risks, safety and benefits are provided, with scientific references and without using product names)
- Informed Consent for Treatment signature panel, for parent and practitioner acknowledgement.
An abbreviated and full version of the scientific references is also provided, with live hyperlinks. In editing this template resource to create your own informed consent form, it is strongly suggested that some form of scientific referencing is included. While using this content to develop your informed consent form, keep in mind that alongside suiting your practice and patient demographic, an ideal informed consent form should include background on myopia, treatment options and their risks and benefits.
This free download can also be found in our online course Communicating the Myopia Message which includes further content on the process of Informed Consent for clinical treatment and off-label prescribing.