---
title: Ophthalmic Medication Refill Request Form Template | Paperform
description: Professional eye care prescription refill form for ophthalmology practices. Track IOP readings, visual field results, and automate ophthalmologist approval workflows with Paperform.
url: "https://paperform.co/templates/ophthalmic-medication-refill-request"
type: static
generatedAt: "2026-03-28T00:44:41.355Z"
---

[← Back to free form templates](/templates/)    ![Ophthalmic Medication Refill Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/ophthalmic-medication-refill-request.png)
    [Preview](https://_preview.paperform.co/ai-template/ophthalmic-medication-refill-request) [Use this template for free](/create?ai-template=ophthalmic-medication-refill-request)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Simplify Eye Care Medication Refills with Paperform

Managing ophthalmic medication refills requires careful coordination between patients, clinical staff, and ophthalmologists. This **Ophthalmic Medication Refill Request** template helps eye care practices, ophthalmology clinics, and optical centers streamline the entire refill process while maintaining rigorous clinical standards.

#### Built for Modern Eye Care Workflows

Eye care specialists know that conditions like glaucoma, dry eye, and post-surgical care require consistent medication management. This template captures essential clinical data—including intraocular pressure readings, visual field test results, and medication history—in one organized submission, reducing phone tag and ensuring nothing falls through the cracks.

Paperform's conditional logic means patients only see questions relevant to their specific situation, while healthcare administrators can route urgent requests differently than routine refills. The form integrates seamlessly with your existing practice management software via Stepper workflows, automatically updating patient records and triggering pharmacist notifications.

#### Automation That Saves Clinical Time

Connect this form to [Stepper](https://stepper.io) to build sophisticated approval workflows. Route refill requests to the appropriate ophthalmologist based on patient assignment, send automatic reminders for required follow-up appointments, and notify your pharmacy partner the moment a prescription is approved—all without manual data entry.

You can also set up automatic patient confirmations, track refill history in your CRM or Google Sheets, and flag patients who may need earlier intervention based on their IOP readings or visual field changes.

#### Professional, HIPAA-Aware Design

While Paperform is not HIPAA compliant, this template provides a professional foundation for practices that handle PHI through compliant channels. The clean, accessible design works beautifully on mobile devices, making it easy for patients to submit requests between appointments or from home.

Whether you're a solo ophthalmologist, part of a multi-location eye care group, or managing an optical practice, this template helps you deliver better patient care while reducing administrative burden. Trusted by healthcare providers worldwide, Paperform gives you the flexibility to customize every field, notification, and workflow to match your clinical protocols.
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