Follow the steps to effectively complete your Patient Information Form.

1. Click ‘Get Form’ button to obtain the Patient Information Form and open it for filling out.
2. Begin by entering your personal health care number if you have one. Then, indicate whether your visit is related to a work injury by selecting 'YES' or 'NO'. If you select 'YES', specify the date of the injury and the claim number.
3. Fill in your first name, last name, and date of birth, ensuring you provide your age as well. Indicate your sex by selecting 'Male' or 'Female'.
4. Provide your primary telephone number and an alternate telephone number if available. Next, enter your primary language and occupation to complete this section.
5. Input your address, including the street address, city, province, and postal code. Additionally, provide your email address for further communication.
6. Next, complete the next of kin section, including their name, relationship to you, and contact phone number.
7. In the medical information section, provide the names of your referring physician and family physician. Indicate if you wear glasses or contact lenses and answer questions about diabetes, high blood pressure, and any other medical conditions.
8. List any allergies (including environmental and medication), as well as all medications you are currently taking, ensuring to include herbal supplements.
9. Answer questions regarding any prostate or urinary incontinence medications and blood thinners you may be taking. Provide information about any past eye diseases or injuries and past eye operations.
10. Finally, if you have had laser refractive surgery, include the surgeon's name and contact number. Complete the ocular family history section as well.
11. Review all entered information for accuracy. Once confirmed, you can save the changes locally, download, print, or share the form as needed.

Complete your Patient Information Form online today to ensure a smooth experience at Seema Eye Care.