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Today s Date Name Birth Date email. What is the main reason for your visit today ex routine vision exam dry eyes itching blurry vision Do you have any drug seasonal or environmental allergies YES OR NO If yes please list them Have you ever had an eye infection injury or surgery YES OR NO If yes please describe Do you experience flashes of Light YES OR NO If yes please describe when Have you ever been a smoker YES No If yes what is your smoking status Current Smoker Former Smoker Have YOU...
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Today's date is 2022-11-23.
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