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First Name: Last Name: Date of birth: / / What problems or symptoms are you currently having with your eye(s)? Rt Eye Lt Eye Floaters/Spots Flashing lights Blurred Vision Distortion/waviness Rt Eye
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What is what problems or symptoms?
What problems or symptoms refer to the issues or signs that a person may be experiencing.
Who is required to file what problems or symptoms?
Anyone who is experiencing any problems or symptoms should report them.
How to fill out what problems or symptoms?
Fill out the information about the problems or symptoms accurately and provide as much detail as possible.
What is the purpose of what problems or symptoms?
The purpose of reporting problems or symptoms is to seek help or treatment and to monitor one's health.
What information must be reported on what problems or symptoms?
Information such as the type of problem or symptom, when it started, its severity, and any related factors should be reported.
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