Medical History Questionnaire - Concourse Optometry 2026

1. Click ‘Get Form’ to open the Medical History Questionnaire in the editor.
2. Begin by answering the allergy question. If you have allergies to medications, select 'yes' and provide details in the space provided.
3. List any medications you are currently taking, including over-the-counter drugs and home remedies, in the designated area.
4. Document any major injuries, surgeries, or hospitalizations you've experienced in the next section.
5. Indicate if you have had any eye conditions such as glaucoma or cataracts by checking 'yes' or 'no' and providing explanations where necessary.
6. Complete the family history section by noting any relevant conditions that run in your family, along with their relationship to you.
7. Fill out your social history, including driving habits and substance use. You can choose to discuss this information directly with your doctor if preferred.
8. Review the systems section carefully. Mark 'yes', 'no', or '?' for each health issue listed and provide additional explanations if needed.
9. Finally, ensure all sections are completed before saving your document for submission.

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