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Date of your last eye exam?
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Do you currently or have you ever had any problems in the following areas?
Do you have a primary medical doctor?
Are you taking any medications?
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Do you drink?
Do you use illegal drugs?
Are you planning on purchasing eyeglasses today?
Any past eye surgeries?
Do you wear contact lenses?
Are you interested in wearing contact lenses?
Have you been diagnosed or treated for any of the following?
Do you experience the following symptoms?
Gritty or sandy sensation
Flashes of light
Blurry vision at distance even with glasses
Blurry vision up close even with glasses
Red, itchy, watery eyes or swollen eyelids
Floaters in vision
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