Patient's Own Frame Waiver
Frame Waiver
I am aware that I am using my own frame and I will not hold my eye doctor, office staff or the optical lab responsible for damages upon insertion of lenses in the frame or during frame adjustments.
Date: ____________________
Patient or legal guardian’s name: ____________________________________
Patient or legal guardian’s signature: ____________________________________
I am aware that I am using my own frame and I will not hold my eye doctor, office staff or the optical lab responsible for damages upon insertion of lenses in the frame or during frame adjustments.
Date: ____________________
Patient or legal guardian’s name: ____________________________________
Patient or legal guardian’s signature: ____________________________________