Patient History Form

Do you use OR have you ever used the following products

Family History (If yes, please indicate who in the family)

Guarantor information required if under the age of 18

Contact Lens Evaluation

The contact lens evaluation includes trial contact lenses, any neccessary follow up visits, as well as training needed to help insert and remove your contact lenses.

If you are a current contact lens wearer, a new evaluation is performed each time you are seen by a doctor.