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© 2018 REED Eye Care Center, LLC 

Tel: 618-398-5005

Fax: 618-398-5169

PATIENT MEDICAL HISTORY FORM

Please print and complete this Medical History Form prior to your exam.

Bring this form to our office and present this to the Medical Receptionist on the day date of your exam.

HIPPA AGREEMENT

Please read, print and sign Notice of Privacy Practices PRIOR to your exam. Signature of this policy is required at time of appointment.

This document is for contact lens wearers new and previous.

This instructional from lists instructions for proper care and maintenance of contact lenses.

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