Goodeyes 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Name, Height, Weight, Age, and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for your care.
3. Indicate your Gender and Pregnancy status by selecting the appropriate options. This helps the medical staff understand your specific needs.
4. Fill out your Race, Primary Language, and Ethnicity by checking the relevant boxes. If you prefer not to disclose any information, select 'Refuse'.
5. In the Medical History section, check 'Yes' or 'No' for each condition listed. Be thorough to provide a complete health background.
6. Continue through Surgery History and Social History sections by providing details about past surgeries and lifestyle habits.
7. Complete the Medication History and Allergies sections by listing all medications you take and any allergies you have.
8. Finally, review all entries for accuracy before signing at the bottom of the form. Your signature confirms that all provided information is correct.

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