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Matthew T. Stanley, O.D. Darcy D. Stanley, O.D. Doctors of Optometry Patient #: PRE-EXAM QUESTIONNAIRE Name: Sex: M F Today s Date: / / Name you prefer to be called: Home Phone: Street Address: Daytime
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How to fill out pre-exam questionnaire - eye
How to fill out pre-exam questionnaire - eye?
01
Start by carefully reading the pre-exam questionnaire - eye form to familiarize yourself with the information being requested.
02
Provide your personal details by filling out your name, age, gender, and contact information accurately.
03
Answer any questions related to your medical history, eye conditions, medications, and allergies truthfully.
04
If there are specific questions about your vision, such as any recent changes, vision loss, or eye surgeries, provide accurate and detailed answers.
05
Pay attention to questions regarding any symptoms you may be experiencing, such as blurred vision, double vision, eye pain, or redness.
06
If the questionnaire asks for information about your lifestyle, mention any factors that may be relevant to your eye health, such as your occupation (if it involves prolonged screen time) or any hobbies that may pose a risk to your eyes (e.g., contact sports).
07
Take note of any additional instructions or requests mentioned in the form, such as bringing any specific documents or wearing your current eyeglasses or contact lenses for the examination.
Who needs pre-exam questionnaire - eye?
01
Individuals who have scheduled an eye examination or consultation with an eye doctor.
02
Patients who have been referred to an ophthalmologist for a specific eye condition or concern.
03
People with a history of eye problems or conditions who are seeking routine check-ups or follow-up appointments.
04
Individuals experiencing any unusual or concerning symptoms related to their vision or eye health.
05
Those who are considering vision correction procedures or options such as LASIK or cataract surgery.
06
Patients preparing for medical or surgical treatments related to the eyes.
07
People participating in clinical trials or research studies related to eye health.
Remember, filling out the pre-exam questionnaire - eye accurately and honestly is essential as it provides your eye doctor with crucial information to evaluate your eye health and determine the appropriate course of action for your specific needs.
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What is pre-exam questionnaire - eye?
A pre-exam questionnaire - eye is a form that needs to be completed before an eye exam in order to provide important information to the eye doctor.
Who is required to file pre-exam questionnaire - eye?
Any individual scheduled for an eye exam is required to fill out the pre-exam questionnaire - eye.
How to fill out pre-exam questionnaire - eye?
The pre-exam questionnaire - eye can be filled out either online before the appointment or at the office prior to the exam.
What is the purpose of pre-exam questionnaire - eye?
The purpose of the pre-exam questionnaire - eye is to gather relevant information about the patient's eye health history, symptoms, and any previous eye conditions.
What information must be reported on pre-exam questionnaire - eye?
Information such as medical history, current medications, eye problems, allergies, and family history of eye conditions must be reported on the pre-exam questionnaire - eye.
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