Get the free Contact Lens History Form

Alan P. Levitt, O.D. Board Certified Optometry Physician Contact Lens Wear History Name:Date:Please answer the following questions as accurately as possible. How many years have you worn contact lenses?

How to fill out contact lens history form

How to fill out contact lens history form

1. Start by writing your full name and date of birth at the top of the form.
2. Indicate whether you are a new or returning patient.
3. Provide your current contact lens prescription information, such as the brand, power, base curve, and diameter.
4. Mention how long you have been wearing contact lenses and if you have any previous experience with different types or brands.
5. Share any issues or complications you have experienced while wearing contact lenses, such as dryness, eye redness, or discomfort.
6. Note any allergies or sensitivities you have that may be relevant to wearing contact lenses.
7. Mention any previous eye surgeries or eye diseases you have been diagnosed with.
8. Describe your cleaning and disinfection routine for your contact lenses.
9. Specify if you wear your contact lenses daily or extend the wear time.
10. Provide any additional information or concerns you may have regarding your contact lens history.
11. Once you have completed the form, review it for accuracy before submitting it to your eye care professional.

Who needs contact lens history form?

1. Anyone who is planning to get or wear contact lenses needs to fill out a contact lens history form.
2. It is required for both new patients who have never worn contact lenses before and returning patients who need to update their contact lens information.
3. The form helps eye care professionals understand the patient's contact lens history, previous experiences, and any potential risks or issues that may arise.

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What is contact lens history form?

Contact lens history form is a document that records the historical details of a person's use of contact lenses.

Who is required to file contact lens history form?

Individuals who wear contact lenses are required to file the contact lens history form.

How to fill out contact lens history form?

Contact lens history form can be filled out by providing details such as date of first use of contact lenses, type of lenses used, reason for use, and any complications experienced.

What is the purpose of contact lens history form?

The purpose of contact lens history form is to track the usage and impact of contact lenses on an individual's eye health.

What information must be reported on contact lens history form?

Information such as date of first use of contact lenses, type of lenses used, reason for use, and any complications experienced must be reported on contact lens history form.