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.