Welcome to Woodbridge Optometry Eye Care Services
This file contains important information about your upcoming visit to Woodbridge Optometry. It includes instruction forms that help ensure a smooth check-in and comprehensive eye examination. Detailed medical history and ocular health screenings are provided to give doctors the insights they need for your eye care.
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How do I fill this out?
To fill out this form, start by providing your personal information such as name, address, and contact details. Next, complete the medical and ocular history sections to help us understand your eye care needs. Lastly, review your responses to ensure all information is accurate before submission.
How to fill out the Welcome to Woodbridge Optometry Eye Care Services?
1
Begin by entering your basic personal information.
2
Fill in the medical history section with accurate details.
3
Complete the ocular history to identify your vision needs.
4
Review your information for accuracy.
5
Submit the form during your visit.
Who needs the Welcome to Woodbridge Optometry Eye Care Services?
1
Patients seeking eye care services.
2
Families requiring pediatric eye examinations.
3
Individuals needing contact lenses or glasses.
4
Patients with ongoing eye health concerns like glaucoma.
5
Anyone interested in scheduling a routine exam.
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What are the instructions for submitting this form?
To submit this form, please bring it to your appointment at Woodbridge Optometry located at 4505 Barranca Pkwy, Suite C, Irvine, California 92604. For questions, contact us at 949-857-0676 prior to your visit. If you prefer, you can fax this form to 949-857-2175 prior to your appointment date.
What are the important dates for this form in 2024 and 2025?
Be sure to review your annual eye exam dates as they can greatly affect your visual health. Important for 2024 and 2025: Schedule regular appointments every 12 months. Ensure you submit your next eye exam request by January 15, 2025, for optimal scheduling.
What is the purpose of this form?
This form serves to gather essential information from patients to provide optimal eye care services. By collecting personal and medical histories, we can tailor our examination and treatment approaches. Ensuring that all patients fill this out accurately aids in delivering effective and personalized eye care.
Tell me about this form and its components and fields line-by-line.
- 1. Full Name: Enter your full name.
- 2. Address: Provide your current address for correspondence.
- 3. Email Address: Your email for appointment confirmations.
- 4. Occupation: Your current job title or role.
- 5. Medical Doctor: Name of your primary medical doctor.
- 6. Medical Insurance: Details about your current medical insurance.
- 7. Previous Eye Doctor: Name of your last eye care provider.
- 8. Vision Insurance: Information regarding your vision insurance coverage.
- 9. Birth Date: Your date of birth.
- 10. Social Security #: Your social security number for record purposes.
What happens if I fail to submit this form?
Failure to submit this form may lead to delays in your eye examination and treatment. The health care team may not have pertinent information to assess your eye care needs adequately. This could result in incomplete evaluations and longer wait times during your visit.
- Delayed Appointment: If the form is not submitted on time, your appointment may be postponed.
- Incomplete Health Records: Lack of submission may lead to incomplete patient history.
- Inadequate Evaluation: Missing information could prevent the doctors from providing optimal care.
How do I know when to use this form?
- 1. New Patients: First-time visitors must complete this form to initiate care.
- 2. Routine Check-ups: Patients seeking annual eye exams need to fill this out.
- 3. Updating Medical History: Existing patients should use this form to update their medical information.
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