Eye Health Update Form Eye Health Update Name*Date of Birth*List all current medications and dosages:* List all environmental and medical allergies:* Check all the eye or vision problems you are currently experiencing:*blurrinesspaindouble visiondrynesswaterinessitchinessheadachesburning eyesred eyesfloating spotsflashing lightsdizzinessHold down CTRL key to select multiple answers.
