Patient Info

Are you wearing contacts (rigid or soft) or glasses? If wearing bifocals, progressive lenses, or reading glasses, please measure the distance from your eyes to any work areas, particularly the computer or music. For new patients, bring all glasses and contact lenses, a contact lens prescription or contact lens box or bottle, or previous eye care records including lens specification. Please remove mascara prior to your exam. Please bring your medical or health insurance card.

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1. Signs or symptoms of eye problems you may have noticed?
   
2. Blurred Vision – Is it blurred at a distance, near, or at the computer?
   
3. Double Vision
   
4. Flashes of light
   
5. Any health problems or allergies?
   
6. Any previous eye disease, surgery, or previous injuries?
   
7. Any family history of eye disease?
   
8. What prescription and over-the-counter drugs are you taking?
9. What sports or hobbies do you participate?