Eye Color Change Health Declaration Form

Eye Color Change Health Declaration Form

Medical Form

"*" indicates required fields

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DD slash MM slash YYYY

Health declaration form

name*
Enter mobile number
Enter your ID number including check digit.
Do you have diabetes or multiple sclerosis?*
Have you had laser vision correction or any other eye-related medical procedure?*
Examples: one month/two years/ten years
Have you ever had an acute eye infection (which required you to go to the emergency room)?*
Do you wear contact lenses? And if so, are they hard or soft? *
For example: I have been using lenses for 3 years.
Do you have difficulty lying on your back with your head facing the ceiling and your gaze straight ahead?*
Things you need to know about your health condition

Medical escort abroad – procedures and conduct

Introduction – FLAAK VISION

Medical escort abroad is an essential service for people with special medical needs, allowing them to travel safely and comfortably to various destinations around the world. This document provides a comprehensive explanation of the important procedures, laws, and recommendations that must be known before and during the trip, with an emphasis on medical support.

Airport procedures

Pre-flight preparations

Required documents:

  • Valid passport (at least six months after return)
  • Visa (if necessary)
  • Medical documents: medical condition, medication list, accompanying equipment
  • Certificate from the attending physician confirming fitness to fly

Medical equipment:

  • Check that the equipment complies with airline regulations.
  • Keep medications in their original, labeled packaging.
  • Prepare a complete list and present it at security checks

Medical insurance:

  • Purchase international medical insurance that covers emergency treatment and medical evacuation

Airport security procedures

  • Announce medical equipment to security staff in advance
  • Liquid medications over 100 ml require special permission.
  • Keep the equipment in an accessible and marked place.

Rights of passengers with special needs

  • Airlines are obligated to provide full assistance
  • Inform the airline of your needs at the time of booking.
  • Arrive at the airport at least 3 hours in advance

Rules and procedures in hotels abroad

accessibility

  • Check in advance that the hotel offers accessible and adapted rooms.
  • Book a room on the ground floor or near an elevator

securing

  • Check the hotel's escape routes and emergency plans.
  • Make sure there are fire extinguishing systems and smoke detectors.

Medical services

  • Find out if there is a contact with a local doctor or emergency services.
  • Prepare a list of nearby hospitals and clinics

Conduct in cities abroad

Public transportation

  • Check accessibility in advance, use navigation apps
  • Accessible taxis – sometimes require advance booking
  • On intercity trains – check for assistance in advance

Accessibility in public spaces

  • Modern cities have wide sidewalks and ramps.
  • At tourist sites – check accessibility options in advance
  • In parks – sometimes there are adapted routes

Emergency medical services

  • Know your local emergency numbers.
  • Prepare a list of nearby hospitals
  • Get phone numbers of private clinics.

Daily tips

  • Check business and restaurant hours of operation.
  • Get to know the local tipping procedures
  • Keep cash in local currency

Additional information and useful tips

List of important telephone numbers

  • Local emergency numbers
  • Israeli Embassy in the destination
  • Nearby hospitals and clinics

Recommended apps

  • Google Maps — for navigation
  • Public transportation apps
  • Basic language apps

Cultural tips

  • Learn basic words in the local language
  • Maintain manners and appropriate behavior
  • Plan your budget accordingly.

Summary

This document is designed to prepare you for safe, comfortable, and enjoyable medical care abroad. Adhering to procedures, familiarizing yourself with the laws, and respecting local culture will ensure a relaxed and safe travel experience for you and the patient.

Chapter 5: FLAAK VISION - Disclaimer

, I confirm that I decided to undergo eye surgery to change color on my own initiative and without any pressure from Eyal Vered. (hereinafter: "FLAAK VISION"), at one of the clinics or hospitals abroad that were recommended to me by FLAAK VISION.

I am aware that the FLAAK VISION team has no medical training, and that their role focuses solely on organizing the logistics of travel for the surgery – including assistance with scheduling appointments, booking flights, lodging, and coordinating with clinics or hospitals abroad.

I confirm that the information provided to me about the surgery is based on data transferred to FLAAK VISION from the performing clinics or doctors only, and that the FLAAK VISION team has no direct connection or any responsibility regarding the performance of the surgery, the medical decision-making process, or the medical outcome.

I declare that I understand that responsibility for the entire surgical procedure and its results lies solely with the hospital or clinic and the performing physician.

Furthermore, I do not and will not have any right to claim or claim of any kind against FLAAK VISION regarding flight arrangements, accommodation, stay, or any other matter relating to the trip and surgery.

I have been advised that it is recommended to purchase travel insurance that covers potential medical complications related to eye surgery. I acknowledge that purchasing such insurance is my sole responsibility.

I assume all risks associated with color change eye surgery and traveling abroad, including – but not limited to – risks related to medical procedures, travel, and stay.

In the event that a claim of any kind is filed against FLAAK VISION, I undertake to compensate FLAAK VISION for any amount paid by them, including attorneys' fees, legal expenses, fines, interest and linkage.

Any dispute or claim relating to this document will be heard exclusively in the competent court in the city of Tel Aviv, Israel.

Chapter 6: FLAAK VISION - Refund Terms for Financial Deposit for Analysis

, I understand that any deposit paid to reserve a surgery date is refundable only if the surgery is canceled at least 14 calendar days in advance.

In the event that the cancellation is received less than 14 days before the surgery date, the deposit is non-refundable for any reason.

Chapter 7: Cultural Behavior and Local Customs

Manners and etiquette abroad

language

In most countries, locals appreciate your efforts to speak their language. Learn some basic phrases in the local language, such as: hello, thank you, please, excuse me. Using these basic words shows respect for the local culture and makes communication easier.

Meals

Meals abroad may be a social or family event. Be sure to arrive on time and not rush during the meal, as sometimes the meal is part of the cultural experience. Get to know the local customs surrounding meals, such as traditional types of food or how it is served.

Tips

Wear clean, neat clothing, especially when visiting restaurants or official sites. In some countries, inappropriate clothing may be perceived as disrespectful. Avoid talking loudly in public places and be sure to maintain cleanliness.

Chapter 8: Additional information and useful tips

List of important telephone numbers

Emergency: Prepare a list of emergency medical, police, and fire numbers at your destination.
Israeli Embassy: Save phone numbers and addresses of Israeli embassies and consulates at your destination.

Links to official websites

The destination's foreign ministry, official tourism websites, and public transportation websites provide essential and up-to-date information for planning.

Useful apps

Navigation and transportation

Google Maps for navigation and directions. Local transportation apps for planning and purchasing tickets.

Language and translation

Duolingo for basic language learning, Google Translate for real-time translation.

health

First Aid by Red Cross with first aid information, MySOS for ordering emergency services (subject to availability).

Additional tips

Be sure to check the weather in advance and plan accordingly. Consider purchasing a local SIM or roaming package. Carry some cash, and check for tourist taxes.

Chapter 9: Tips for dealing with animals (service dog)

At the airport

Make sure the service dog has a vaccination certificate and permits. Notify the security team in advance.

At the hotel

Check if the hotel allows service dogs and let them know in advance. Some hotels offer special services for dogs.

On a city trip

Check which sites and transportation allow service dogs. Most public transportation allows this, but check in advance.

Special events and festivals

Check the destination's events calendar in advance. Avoid crowded areas with a person with special needs.

Chapter 10: Procedures and behavior in hotels abroad

Hotel check-in and registration

At check-in, present a passport and credit card. Check check-in times and tourist taxes.

Conduct in the hotel room

Keep quiet, avoid smoking in the rooms. Check the terms of use of the minibar and the Internet.

Services and facilities at the hotel

Pools, spa, gym, and restaurants — be sure to check operating hours and usage procedures.

Safety and security

Use a safe to store valuables. Know your escape routes. Always lock your room door.

Check-out

Check check-out times and ask for a summary bill. Luggage can be left at the hotel after departure.

Additional tips for hotel behavior

Be polite, leave a tip as is customary, and contact the staff with any problems or requests.

Recommended activities during rest

During recovery, it is recommended to rest with your eyes closed, avoid bright light, and listen to music or audiobooks.

If you've read this far, it means you're ready for an unforgettable experience abroad! We're here to make sure your experience is as smooth and enjoyable as possible.