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Eye Gallery Of Scarsdale
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Are you experiencing any symptoms of COVID(fever, cough, shortness of breath) OR been exposed to others in last two weeks who have*
If yes please describe below or type no.
Reason for visit?
Please type your answer below. —routine exam —eye infection —contact lens evaluation
Please type your answer below .
Allergies to medications? (y/n)
if yes then name the medications
Wear eye glasses (y/n)
Please type your answer below. —if yes for distance, near, or both
Wear contacts (y/n)
Please type your answer below. If yes then name brand and if possible Rx
Personal Eye History
Please type your answer below. —surgery (y/n) if yes name type of surgery —trauma (y/n)
Family history eye disease (y/n)
if yes then name disease
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