DILATION OF THE PUPILS is historically recommended for all new patients and at scheduled intervals for others. If you must postpone the dilation today for a more convenient time, please sign below indicating that you understand that there may be diseases or other problems of the eye or body such as, but not limited to, peripheral retinal defects, detachments, or other pathology; all of which may or may not be associated with pain or vision loss, that were not ruled out today. I, therefore, do not hold Carol Hecker Nason, O.D., P.A., or its associates liable for any delay in diagnosis or treatment that is a result of my not being dilated today. I understand that it is my responsibility to reschedule the dilation and I understand that there is no charge if completed within 30 days. Dilation of the pupils and it's associated side effects (blur and sensitivity to light) can last as long as 4-5 hours.
DO NOT SIGN ANY LEGAL OR FINANCIAL DOCUMENTS WHILE DILATED.