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Privacy Consent
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Did the patient receive the privacy and informed consent notice and did they provide verbal agreement?
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Patient has verbally consented
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Patient is aware of their right to refuse to participate
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Video Assisted Eye Exam (if applicable)
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Video Assisted Eye Exam
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Chief Complaint
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101| CC
• • •
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Secondary Complaint
• • •
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102| Notes
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108| Are you interested in renewing your contact lens prescription?
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104| Was your last exam at Warby Parker?
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103| LEE
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LEE Additional Notes
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LDFE
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LDFE Additional Notes
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