📝 Pre-Appointment Questionnaire
Consider the following questions. This will help your eye care provider understand your needs and medical history. No data is stored or saved. Once you leave this page, your information is deleted.
What is the main reason you're seeing the eye doctor today? How long has this issue been going on? Has it been getting better, worse, or staying the same?
Have you seen an eye doctor before (optometrist or ophthalmologist)? If yes, when and why? Do you wear glasses or contact lenses? Have you had any previous eye surgeries or procedures?
Please list any eye drops or other eye-related medications you currently use.
Does anyone in your family have a history of eye conditions (e.g., glaucoma, macular degeneration, retinal detachment)?
Please list any medical conditions you have (e.g., diabetes, high blood pressure, autoimmune disease, etc.).
Please list any medications you currently take and their purpose (if known).
Do you have any allergies, including to medications or eye drops?