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Patient Name:DOB:MEDICAL HISTORY QUESTIONNAIREDate of last eye exam: Who is your family physician(s)?: Have you ever been diagnosed with following?YESNOYESNOYESNOCataract Age related macular degeneration
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The 'eye doctor montgomery alour' likely refers to a form or documentation related to eye care or ophthalmology in Montgomery, Alabama.
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