Get Medical History Questionnaire - Concourse Optometry 2020-2025

Completing the Medical History Questionnaire for Concourse Optometry is an essential step in ensuring you receive the best eye care tailored to your needs. This guide will walk you through the process of accurately filling out the form online to facilitate your appointment.

Follow the steps to successfully complete the questionnaire.

1. Press the ‘Get Form’ button to access the Medical History Questionnaire and open it for editing.
2. Begin by addressing allergies. Indicate whether you have any allergies to medications by selecting 'yes' or 'no.' If you answer 'yes,' provide a brief explanation in the designated space.
3. List all medications you currently take, including over-the-counter drugs, supplements, and home remedies. Ensure you include any oral contraceptives and aspirin as well.
4. Document any major injuries, surgeries, or hospitalizations you have experienced. This information is crucial for understanding your medical history.
5. Indicate any previous eye conditions you have had, such as glaucoma or retinal disease. Provide specifics in the provided space.
6. State your current pregnancy or nursing status by selecting 'yes' or 'no.'
7. If you wear glasses, select 'yes' and note the age of your current lenses. If you do not, select 'no.' Repeat this process for contact lenses.
8. For your contact lenses, specify the type (rigid, soft, extended wear, or other) and indicate whether they are comfortable.
9. Complete the family history section by noting any relevant conditions affecting your relatives, as instructed.
10. Address your social history. You can choose to discuss this section privately with your doctor. Indicate your driving status and any visual difficulties you may encounter.
11. Report on tobacco, alcohol, and illegal drug use, along with any exposure to infectious conditions.
12. In the review of systems section, respond to whether you have had issues in various health areas. For any 'yes' responses, provide additional explanations and list any medications.
13. Upon completing the form, you can save your changes, download or print a copy, or share the completed document with your healthcare provider.

Start filling out your Medical History Questionnaire online today to ensure comprehensive eye care!