Fillable Dry Eye Intake Form – Digital PDF for Targeted Evaluations 🌿👁️
Build your dry eye clinic with this comprehensive, fillable PDF intake form—designed specifically for dry eye evaluations. Whether used at check-in or sent ahead of a consultation, this form helps patients arrive prepared and gives you the insights you need to deliver effective, personalized care.
Thoughtfully organized to uncover underlying causes of dry eye, it supports stronger treatment plans, clearer communication, and more efficient follow-up visits.
Form includes:
✔️ Symptom review with built-in SPEED questionnaire
✔️ Lifestyle habits and makeup use
✔️ Contact lens and ocular health history
✔️ Relevant medical background
✔️ Work/home environmental factors
✔️ Prior treatment history
✔️ Patient goals and expectations
Perfect for:
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Growing your dry eye specialty clinic
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Standardizing documentation across visits
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Enhancing treatment planning and patient engagement
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Reducing chair time and improving follow-up efficiency
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Helping patients clearly communicate their symptoms and needs
Designed for digital use—fillable, professional, and easy to integrate into your workflow.
This listing is for a customized fillable PDF file. For printed version, click here.
Special Notes: Please attach logo prior to purchasing!
