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Home » Contact Us » PATIENT MEDICAL HISTORY

PATIENT MEDICAL HISTORY

Do you or a family member have a history of the following
Diabetes
High Cholesterol
Thyroid Disease
Heart Disease
Arthritis
Headaches/Migraines
High Blood Pressure
Cancer
Asthma
Do you currently experience or have a history of the following?
Blurred vison at distance
Double Vision
Floaters or Spots
Eye Pain/Soreness
Mucous Discharge
Sensitivity to Light
Redness
Blurred Vision at Near
Tired/Watery Eyes
Infection of Eye or Lid
Halos/Glare
Loss of Vision
Strabismus (crossed eye)

CONTACT LENS HISTORY