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Do you have Any OF:

Patient Dilation Consent Form
The dilation will make reading things up close difficult, and make lights seem brighter than usual. This will last for 2-3 hours, although it can last longer in some people.  Most people will be able to drive once their eyes are dilated, as long as they have sunglasses. However, if you feel uncomfortable driving, or have never driven with your eyes dilated, it may be best to have a driver. 

Please check one of the following:

In refusing to have my eyes dilated, I understand that I am assuming all risks associated with failure to diagnose eye conditions due to lack of information, which may have been provided by this. 

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