PATIENT OCULAR and MEDICAL HISTORY FORM Medical Doctor Previous Eye Doctor formnew 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name, phone number, and age.
3. Indicate whether you are diabetic by selecting 'Yes' or 'No'. Fill in the details of your medical doctor and previous eye doctor, including how many years you've been seeing them.
4. Specify the reason for your visit from options like yearly exam, diabetic evaluation, or cataract evaluation. You can also list any eye symptoms you have experienced.
5. In the medications section, list all medications, pills, and eyedrops you are currently using. If none, select 'No'.
6. Complete the drug allergies section by listing any known allergies. Provide a detailed past medical history including ocular history and family medical history.
7. Fill out your social history regarding alcohol consumption and smoking habits. Indicate if you drive and share any hobbies or special interests.
8. Finally, answer questions about your current eyeglass lenses and contact lenses usage. Indicate satisfaction with your current glasses.

Start filling out your PATIENT OCULAR and MEDICAL HISTORY FORM today for free on our platform!