Adult Patient History

Ocular History

Was your last eye exam at our office?

If no, who did you last see and when?

Do you see an Ophthalmologist (specialist)?

If yes, who do you see?

Do you wear glasses?

If Yes:

Do you wear contact lenses?

Do you wear sunglasses?

Does your job/hobby require safety glasses?

Visual Concerns and History

Please check all that apply

Medical History

Please check all that apply

Please list your medications or supplements below or bring a list:

Our Office Hours

Monday

8:30am - 12:00pm
1:00pm - 5:00pm

Tuesday

8:30am - 12:00pm
1:00pm - 5:00pm

Wednesday

8:30am - 12:00pm
1:00pm - 5:00pm

Thursday

11:00am - 3:00pm
4:00pm - 8:00pm

Friday

8:30am - 12:00pm
1:00pm - 5:00pm

Closed Saturday, Sunday and Stat Holidays