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CONTACT LENS AGREEMENT

Please be informed: contact lenses are classified as medical devices with a limited lifespan, regulated by the U.S. Food & Drug Administration. In compliance with the guidelines established & enforced by the FDA & Colorado State Law, the validity of a contact lens prescription is not to exceed one year. Protect your eye health by knowing the risks associated with contact lens use. Please review each statement below. If any clarification is needed, please ask:

1. All contact lens users MUST have a pair of eyeglasses to use in situations when contact lenses cannot or should not be worn.

2. You must remove your contact lenses right away if you have: eye pain, redness, watery eyes or discharge, blurry vision, sensitivity to light

3. If any of the above signs or symptoms are experienced, stop wearing the contact lenses and wear your eyeglasses then contact your optometrist for instructions & schedule an evaluation of your condition. Early diagnosis and treatment will minimize the potential for scarring of eye tissue.

4. It is important to limit the wearing time of your contact lenses. Overwearing lenses can potentially scratch the front cells of the cornea. Avoid sleeping in contact lenses to decrease the risk of eye infections & permanent scarring.

5. Contact lenses are fragile & need to be replaced routinely due to normal wear caused by daily handling & cleaning. Be sure to clean your contact lens case & replace your case each year or sooner! It is also important to keep the contact lenses clean by washing your hands well with an oil-free soap.

6. Proper lens care includes gentle handling & only using approved cleaning solutions. Unacceptable rinsing & storage solutions include water from: a tap, well, lake, swimming pool, hot tub, distilled water or saliva.

7. An annual eye examination is required for the renewal of a contact lens prescription since a contact lens prescription can only be valid for one year, in accordance with current FDA regulations.

Please note: All contact lens examinations / fittings include unlimited follow-up visits for 3 months after the initial eye examination. There will be a minimal office charge for visits AFTER the 3 month period. In the unusual event that it becomes impossible to wear contact lenses, it is possible for the doctor to recommend the discontinuation of contact lens wear, in which case professional examination fees / fitting fees are not refundable.

Date: August 10, 2020

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