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glaucoma 2
wprasel
2019-12-25T15:06:25-05:00
Have you been diagnosed with glaucoma?
Yes
No
What is your vision acuity?
Date of Birth
Date Format: MM slash DD slash YYYY
What is your address?
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Have you had eye surgery in the last 3 months?
Yes
No
Have you had eye surgery in the last year?
Yes
No
Are you currently taking any medication for your glaucoma? (Yes, no) If yes, which medication?
Have you taken any medication for your glaucoma in the past? If so, which medication?
Do you have diabetes
yes
No