Fillable PDF Version of Dry Eye Patient Intake Form


Comprehensive patient intake form specifically structured for a dry eye evaluation visit. Includes everything from symptoms (with built-in SPEED questionnaire), habits, make-up use, contact lens history, relevant medical history, work and home environmental factors, success of previously attempted treatments, and patient's goals for treatment. 

If you're trying to build up your specialty dry eye clinic, this form provides a solid framework for gathering patient history to help determine commonly overlooked causes and establish a treatment plan that will accomplish your patient's goals AND prevent disease progression. 

This listing is for a customized fillable PDF file. For printed version, click here

Special Notes: Please attach logo prior to purchasing!