Health History Form & Lifestyle Questionnaire 2026

1. Click ‘Get Form’ to open the Health History Form & Lifestyle Questionnaire in the editor.
2. Begin by filling out the Patient Information section. Enter your name, date of birth, gender, height, weight, and details about your last eye exam and primary care physician.
3. In the Spectacle/Contact Lenses section, indicate whether you wear glasses or contact lenses and provide additional details as prompted.
4. Next, complete the Computer Use section by selecting how many hours per day you spend on screens and whether you use computer glasses.
5. Proceed to the Sports & Leisure section. List any sports or hobbies you participate in and specify if you wear special eyewear for these activities.
6. Fill out the Dry Eye Questionnaire by checking off severity and frequency of symptoms as instructed.
7. Complete the Review of Systems and Medical History sections by checking applicable boxes regarding current symptoms and past medical conditions.
8. Finally, review all entered information for accuracy before signing at the bottom of the form to verify its correctness.

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