Minor Wearer’s Ortho K Contract

Minor Wearer’s Contract I am being fitted with gas permeable (GP) contact lenses; Corneal Refractive Therapy is an example of GP lenses. These contact lenses reshape the cornea (the clear layer on the front of the eye) while sleeping for a short time, which allows me to see clearly without the use of glasses or contact lenses while I am awake. The Corneal Refractive Therapy contact lenses must be worn on a regular basis during sleep so that I can see clearly during the day without glasses or contact lenses. It is important that I agree to the following guidelines to keep my eyes healthy and allow me to wear contact lenses. Place a check mark in each box if you agree. ☐ I agree to wear my lenses while I sleep at night. ☐ I agree to wash my hands before inserting or removing my contact lenses. ☐ I agree to clean my lenses with CooperVision Refine One-Step each time I remove them. ☐ I agree not to rinse my contact lenses in water from the sink. I will only use contact lens saline to rinse my contact lenses. ☐ I agree to tell my parents or my doctor immediately if my contact lenses irritate my eyes. ☐ I agree to tell my parents or my doctor immediately if my eyes appear red or are painful. Minor’s Name: ____________________ Date: _____________