New Patients Ages 0-5

If your child has not yet entered school, this history form can help us get the information we need to make sure your child's visit to our office visit goes as smoothly as possible. Please take the time to print and fill out this form prior to bringing your child to our office.

This form asks questions about any medical symptoms, signs, medications, or social history issues that are of importance to your eye and general health. Please take the time to print and fill out this form prior to coming to our office. This will help expedite your visit.