Are your patients overwhelmed by all the signatures? It may be time to reconsider your approach. Photo courtesy of Dr. Laurie Sorrenson.
Too many signatures? Rethinking the forms we ask patients to sign
By Laurie Sorrenson, OD, FAAO
April 3, 2026
If you walk into many optometric practices today, you’ll be handed a clipboard—or an iPad—with a stack of forms to sign before anyone even checks your vision.
- HIPAA acknowledgement
- Financial policy
- Signature on file
- Contact lens prescription release
- Glasses prescription release
- Consent to treat a minor
- PD form
- Patient-owned frame liability waiver
- Dilation consent
- Retinal imaging consent
- Dry eye consent
- Myopia management consent
- Generic ABN
- Notice that medical will be billed if medical condition found
Sign here. And here. And here.
Are we collecting signatures because we truly need them—or because we’re afraid not to?
The Forms We Actually Have to Have
I asked Joe DeLoach, OD, from Practice Performance Partners, about the forms we must have.
Let’s start with the obvious. Some forms are legally required or strongly recommended.
- HIPAA Notice of Privacy Practices acknowledgement (at minimum once, and updated if policies materially change—many practices refresh every few years)
- Contact lens prescription release acknowledgement under the FTC Contact Lens Rule (or documentation that it was provided electronically via a portal)
- Glasses prescription release acknowledgement under the FTC EyeGlass Rule (or documentation that it was provided electronically via a portal)
- Consent to treat a minor
- Certain consents tied to specific medical procedures, depending on your state and scope
Do you have “Just in Case” Forms?
Over time, we accumulate forms for rare scenarios:
- Signature on file for future charges
- Patient-owned frame—no liability if it breaks
- Not responsible if insurance denies a claim
- No guarantee on non-adapt lenses
- No refund on custom lenses
- Medical vs. vision explanation acknowledgement. (According to Dr. DeLoach, the way this form is worded can be illegal. You can’t bill medical if the reason for the visit doesn’t match the finding. He also said that generic ABNs are not legal.)
Each of these forms is typically born out of a single painful experience.
A frame broke once.
A patient disputed a charge once.
An insurance company denied a claim once.
And in response, we create a form to prevent it from ever happening again.
Too Many Signatures? Here’s what I think
A signature doesn’t eliminate conflict. It just documents it.
If a patient is upset, the fact that they signed something weeks ago rarely changes the emotional temperature of the conversation. And it certainly doesn’t guarantee payment.
In my experience, many of these “extra” forms give us a psychological sense of protection more than a practical one.
Take the “patient-owned frame—no liability” form.
Yes, occasionally an older frame breaks during lens insertion. It happens. But in our practice, that is rare. Very rare.
Does having every single patient sign a waiver:
- Prevent the frame from breaking?
- Prevent the patient from being upset?
- Guarantee they’ll pay for a replacement?
Probably not.
If the frame breaks, we still have to navigate the relationship. We still have to decide whether preserving goodwill is worth absorbing the cost.
The signature does not remove that decision. In our practice, if we take the patient’s frame to put lenses in it, then we are responsible. Not everybody does it that way, but having a signed form from weeks or months ago rarely helps.
The Hidden Cost to the Patient Experience
Here’s the bigger issue: every form we add creates friction.
One of my ongoing goals is to make the patient experience as frictionless as possible. Every extra clipboard, every unnecessary signature, every redundant document adds friction. Having a frictionless or effortless experience is essential for practice growth. (Read more here.)
Forms you don’t truly need? They create friction. I recommend that you eliminate as many as you can.
Think about it from the patient’s perspective. They come in for an eye exam.
Before they’ve seen a smiling team member or had a meaningful interaction, they’re signing legal disclosures, liability waivers, financial acknowledgements and pages of fine print.
What does that subtly communicate? “We’re protecting ourselves from you.”
That may not be our intention—but it can feel that way. I know it does to me when I walk into a medical office and immediately get handed a stack of documents to sign. I find it frustrating.
In a world where we’re trying to differentiate ourselves through service, hospitality and trust, we have to be careful that our processes don’t contradict our culture.
Don’t Let the Outliers Run Your Business
Design your systems for what happens 95% of the time—not for the 5%.
Most patients pay their bills.
They don’t dispute charges, file frivolous complaints or try to return worn custom lenses. Most patients don’t bring in 15-year-old frames expecting miracles.
If something happens once every few years, requiring 100% of patients to sign a document is rarely the best operational response.
Instead, I’d rather document important conversations in the chart, and handle rare issues case-by-case with maturity and consistency.
Paperwork for everyone isn’t leadership. It’s fear management.
Signatures Don’t Replace Leadership
As owners, it’s tempting to try to eliminate risk with paperwork.
But leadership is about judgment. It’s about making sure your team understands your culture—and knows how you would handle those rare situations.
Just this past week, I had two moments that reminded me our team “gets it.”
One phone team member helped a contact lens patient who wasn’t even ours. No hesitation.
Another patient wanted to switch frames on her Ray-Ban Metas. Those aren’t returnable. My team didn’t need to ask me. They made it right.
That’s our culture. It may not be yours. But whatever your culture is, I think your team should know it well enough to act without hiding behind a form. (Here’s the article I wrote about how to train for that. )
Maybe It’s Time to Re-Evaluate
If you currently require signatures for the following, ask yourself whether you truly need them:
- Financial policy
- Patient has to pay if insurance doesn’t
- Signature on file
- PD form
- Patient-owned frame liability waiver
- Dilation consent
- Retinal imaging consent
- Generic ABN
- Refraction ABN
- Notice that medical will be billed if a medical condition is found
We have exactly ZERO of those.
Read another column by Dr. Sorrenson here.
Read more insights from our editors here.
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Laurie Sorrenson, OD, FAAO, ABO, is president of Lakeline Vision Source in Cedar Park, Texas, CEO of ODs Care working with Half Helen, Director of Practice Management and Austin Administrator of Vision Source and the Professional Editor of Review of Optometric Business (ROB). To contact her: lsorrenson@gmail.com |
