• If yes please describe below or type no.
  • If yes please describe below or type no.
  • Please type your answer below. —routine exam —eye infection —contact lens evaluation
  • Please type your answer below.
  • Please type your answer below. —if yes for distance, near, or both
  • Please type your answer below. If yes then name brand and if possible Rx
  • Please type your answer below. —surgery (y/n) if yes name type of surgery —trauma (y/n)
  • if yes then name disease