PATIENT MEDICAL HISTORY Do you or a family member have a history of the followingDiabetes Self M F GF GM High Cholesterol Self M F GF GM Thyroid Disease Self M F GF GM Heart Disease Self M F GF GM Arthritis Self M F GF GM Headaches/Migraines Self M F GF GM High Blood Pressure Self M F GF GM Cancer Self M F GF GM Asthma Self M F GF GM List major surgeries, injuries, or hospitalizations List all Medications you take (including over the counter supplements and eye drops) Any ALLERGIES to medications or Food? Are you pregnant or nursing? Do you currently experience or have a history of the following?Blurred vison at distance Yes No Double Vision Yes No Floaters or Spots Yes No Eye Pain/Soreness Yes No Mucous Discharge Yes No Sensitivity to Light Yes No Redness Yes No Blurred Vision at Near Yes No Tired/Watery Eyes Yes No Infection of Eye or Lid Yes No Halos/Glare Yes No Loss of Vision Yes No Strabismus (crossed eye) Yes No Other (Explain) CONTACT LENS HISTORYDo you currently wear contact lenses? What type/brand do you wear? How often do you replace your contact lenses?