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Medical History Questionnaire South Tulsa

Reason for Today's Visit

REVIEW OF SYSTEMS:

Do you currently, or have you ever had any problems in the following areas?

SURGICAL HISTORY: Includes any surgery as well as eye surgery

COMPUTER USAGE

PAST / PRESENT OCULAR HISTORY: Circle all that apply as well as a date the condition was diag- nosed. Also, put down any blood relatives that have that same condition and their relationship to you.

Condition, Date Diagnosed, Family History

SOCIAL HISTORY:

Have you ever been exposed to or infected with:

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Office Hours

 South Tulsa

DayMorningAfternoon
Monday8:00am5:00pm
Tuesday8:00am5:00pm
Wednesday8:00am5:00pm
Thursday8:00am5:00pm
Friday8:00am5:00pm
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00am 8:00am 8:00am 8:00am 8:00am Closed Closed
5:00pm 5:00pm 5:00pm 5:00pm 5:00pm Closed Closed


 


 


 

 Okmulgee

Monday 8:00 am 5:30 pm
Tuesday 8:00 am 5:30 pm
Wednesday 8:00 am 5:30 pm
Thursday 8:00 am 5:30 pm
Friday 7:00 am 5:30 pm
Saturday Close Close
Sunday Close Close