Intake form special wavefront-guided lenses

Dear Madam, Sir

The first step towards your wavefront-guided lens examination has been taken! Could you please provide as much of your eye data as possible, it will help me prepare for your visit. After you have completed and submitted the form, you can immediately schedule a time for an introductory appointment via Google Meet, if you appreciate it

So in brief:

  1. Fill in the information sheet below.
  2. When sending, do or do not choose a Google Meet video appointment
  3. If you choose the Meet appointment, you will be immediately redirected to choose an available one day and time.

Intake formulier:

    First time patient ?

     
     
     

     
     
     

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    HEALTH CONCERNS / SYMPTOMS
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    Can you send me as much relevant information about your eyes as possible before your visit to my practice ?

    Add files:



    I would like to have an introductory meeting with you via Google Meet, is that okay with you, then you will get the option to make a appointment after you sent this form.