Forms and Tools for Your Practice
Below are downloadable materials to help you manage your eye care practice, such as a satisfaction questionnaire and an action plan. You will also find forms and tools such as questionnaires and trackers to help you assess patients, get them started on treatment, and track their progress.
We will frequently add new materials to this website. To be alerted when new materials
are available, simply enter your information in the Register for Updates
box to the right.
Click on the categories below to access helpful glaucoma, dry eye, or allergy
forms and tools.
Sample Action Plan for Practice Enhancement
One-page plan for listing actions to be performed, staff member responsible for
each, and the timeline for completion
Download
Dry Eye Patient Satisfaction Program
Steps to obtaining meaningful data that help gauge the satisfaction level of patients
Download
Glaucoma Tracker Sheet #1
A flow sheet to collect and track information such as intraocular pressure, visual
field, and other test results over time
Download
Glaucoma Tracker Sheet #2
Similar to Tracker Sheet #1, but with additional questions to collect information
about allergies, family history, and more
Download
Glaucoma Start-up Sheet With Treatment Plan
One-page patient handout that sets expectations for the treatment plan and includes
an area to write their new medication, dosing, and any special instructions
Download
Dry Eye Questionnaire
One-page questionnaire for use in the waiting room to collect a brief medical history and
relevant personal data related to dry eye
Download
Dry Eye Quiz
A short, 1-page screener to quickly assess your patients' degree of eye irritation
and sensitivity
Download
Next, click one of the buttons below to access information about patient savings
and an assistance program: