Get What Are Your Visual Symptoms Today: Please Circle Any That Apply ...

Filling out the 'What Are Your Visual Symptoms Today' form online is an important step in capturing your current visual health symptoms. This guide will provide you with clear instructions to navigate the form effectively and ensure that all necessary information is accurately reported.

Follow the steps to complete the form accurately and efficiently.

1. Click the 'Get Form' button to access the form. This action will allow you to open the document and begin entering your information.
2. Start by entering your personal details, including your last name, first name, middle initial, and date of birth. Make sure to fill in all required fields marked appropriately.
3. Indicate your gender by selecting M or F and provide your social security number and marital status. Use the drop-down menu options to choose your status.
4. Fill out your contact information, including your address, phone numbers, email, and preferred contact method.
5. Provide emergency contact details, including their name, relationship to you, and phone number.
6. Complete the medical history section by checking any health conditions that apply to you. Be sure to list any medications related to these conditions.
7. In the visual symptoms section, carefully circle any symptoms that you are experiencing today. For each symptom, indicate whether it applies to your right, left, or both eyes, and rate the severity from 1 (low) to 3 (high).
8. Once you have filled in all relevant sections, review your information for accuracy to ensure that everything is correct.
9. Finally, save your changes, and you may have options to download, print, or share the completed form, depending on your needs.

Complete your documents online today for a streamlined experience.