Please read this guide carefully and complete the form below. Contact lenses are medical devices and must be used as prescribed. Improper use can lead to serious eye health complications.
Contact Lens Wearing & Caring Guide
Contact Lenses Are a Medical Device
Contact lenses are FDA-regulated medical devices that require a valid prescription from a licensed eye care provider. Unlike over-the-counter products, contact lenses interact directly with your eye tissue and therefore carry inherent risks when not used properly.
At The Vision Hub at Freeport, we are committed to your eye health and safety. This guide is designed to ensure you have all the information necessary to wear your lenses safely and comfortably. Please review each section carefully before signing.
Risks of Improper Contact Lens Wear
Your eye care provider at The Vision Hub at Freeport wants to ensure you understand the potential risks associated with contact lens wear. When contact lenses are worn improperly, the following complications may occur:
Eye Infections
Bacterial, viral, and fungal infections including Acanthamoeba keratitis — a rare but potentially vision-threatening infection caused by a microscopic organism found in water sources.
Corneal Abrasions
Scratches on the surface of the eye caused by ill-fitting lenses, debris caught beneath the lens, or improper insertion and removal technique.
Corneal Ulcers
Open sores on the cornea that can develop from infections or prolonged lens overwear. Corneal ulcers are painful, can cause permanent scarring, and may lead to vision loss.
Corneal Hypoxia
Insufficient oxygen supply to the cornea caused by extended or overnight wear of non-approved lenses. Symptoms include redness, discomfort, swelling, and abnormal blood vessel growth.
Wearing Schedule & Lens Care Guidelines
To protect your eye health and get the most from your contact lenses, please follow these essential guidelines provided by your eye care provider at The Vision Hub at Freeport:
Wearing Schedule
Cleaning & Care
Hygiene & Safety
Contact Lens Types
Your eye care provider at The Vision Hub at Freeport has prescribed the following type of contact lenses. Please review the care and wear instructions specific to your lens type:
Daily Lenses
Wear and discard every day. No cleaning or storage required. Ideal for occasional wearers or those with allergies. A fresh lens each day provides maximum hygiene and comfort.
Care Instructions: Single use only — never rewear. Do not attempt to clean or store daily lenses overnight.
Monthly Lenses
Can be worn daily for up to 30 days. Must be cleaned and stored each night. Requires the use of a contact lens case and prescribed cleaning solution.
Care Instructions: Clean, rinse, and disinfect lenses each night. Replace the case every 3 months. Discard lenses at the 30-day mark.
Monthly Sleep-In Lenses
FDA approved for up to 30 days of continuous wear, including overnight. These lenses allow higher oxygen permeability. Must be prescribed and approved by your eye care provider before extended overnight use.
Important: Consult your doctor before extended wear. Regular follow-up exams are especially important with these lenses.
Warning Signs — When to Remove Your Lenses
Remove your contact lenses immediately and contact The Vision Hub at Freeport at (850) 880-6778 if you experience any of the following symptoms. Ignoring warning signs may lead to serious eye injury or vision loss.
Informed Consent Agreement
Please read the following informed consent statement in its entirety. By signing below, you acknowledge that you have read and understood this Contact Lens Wearing and Caring Guide and agree to all terms outlined herein.
Informed Consent Statement
I, the undersigned, confirm that I have received, read, and fully understand the Contact Lens Wearing and Caring Guide provided to me by The Vision Hub at Freeport. I agree to follow all recommended wearing schedules, care instructions, and hygiene practices as directed by my eye care provider.
I understand and acknowledge the following:
- Contact lenses are FDA-regulated medical devices that require a valid prescription.
- Improper use of contact lenses may result in serious eye complications including infections, corneal abrasions, corneal ulcers, corneal hypoxia, and in severe cases, permanent vision loss.
- I must not exceed the prescribed wearing schedule and must replace lenses on the schedule recommended by my provider.
- I must use only the contact lens solutions recommended by my eye care provider and must never use water or saliva to clean, rinse, or store lenses.
- I must practice thorough hand hygiene before handling lenses at all times.
- I must not wear contact lenses while swimming, showering, or in hot tubs.
- I must attend annual contact lens exams as recommended by my provider and understand that contact lens prescriptions expire.
- I must remove my lenses immediately and seek prompt care from my eye care provider if I experience any warning signs including redness, pain, discharge, blurred vision, or light sensitivity.
- I have been given the opportunity to ask questions and all my questions have been answered to my satisfaction.
I freely and voluntarily consent to wearing contact lenses as prescribed and accept responsibility for following all instructions provided to me. I understand that The Vision Hub at Freeport is available to answer any questions I may have regarding my contact lens wear and care at any time. Please do not hesitate to contact our office at (850) 880-6778.
Patient Information & Signature
Please complete all required fields below. If the patient is a minor (under 18 years of age), a parent or legal guardian must also sign this form.
Patient Information
Patient Name: _______________________________________________
Date of Birth: _________________________________________________
Date: ________________________________________________________
Contact Lens Type Prescribed (check all that apply):
☐ Daily Lenses – Wear and discard every day
☐ Monthly Lenses – Wear up to 30 days with nightly cleaning
☐ Monthly Sleep-In (Extended Wear) Lenses – FDA approved for up to 30 days continuous wear
Patient Signature: _____________________________________________
Date: ________________________________________________________
Parent / Guardian Information
To be completed only if the patient is a minor (under 18 years of age).
Parent / Guardian Name: _________________________________
Parent / Guardian Signature: ______________________________
Date: ________________________________________________________
By signing above, I certify that I am the legal parent or guardian of the patient named on this form and that I have read and agree to all terms of the Contact Lens Wearing and Caring Guide on behalf of the minor patient.
Questions? We're Here to Help.
If you have any questions or concerns about your contact lens care instructions, wearing schedule, or this consent form, please don't hesitate to contact our team at The Vision Hub at Freeport. We are always happy to help ensure your contact lens experience is safe, comfortable, and successful.
Call us at (850) 880-6778 or visit us at 271 FL 20, Freeport, Florida 32439.