Please complete this form as much as you can, especially in regards to family history including both paternal and maternal side using abbreviations , example mgf=maternal grandfather.

Also include your complete health history, since many eye diseases related to your health and family history can help us make a better diagnosis or watch for certain hereditary diseases.

This form is customized with questions pertaining to our exam for children 12 years of age or under. Having as much health information as possible helps our Doctors manage the health of your child's eyes as they grow.

You may fill out this form prior to your appointment so that your next pair of glasses are designed to best suit your daily needs and lifestyle.Please click the title above to download and print the form.

Are you a computer user and suffer from any of the following symptoms while working on the computer: neck pain, headaches, eyestrain, blurred vision, burning/red eyes, back pain, etc.? If so, then you may be experiencing Computer Vision Syndrome. Please fill out this questionaire so that the doctor can decide if you will need glasses designed specifically for computer use. Click the title above and download, then print.