Eye Surgery Medical History Questionnaire

Form Template

The Eye Surgery Medical History Questionnaire mobile app is designed to pre-screen new patients for Ophthalmology practices.

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The app can be used to collect patient information including personal and medical history. You can also document previous eye exams and eye diseases. This app can be downloaded to an iPhone, iPad, or Android device.

Since this app is customizable, you can also list previous eye care examinations, prior use of vision corrections and surgical procedures, such as cataract surgery, contact lenses, or laser eye surgery.

All eye care reports are saved on the GoCanvas Cloud and can be printed or emailed as a PDF if you need to share it with others.

Features
  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

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Dave Kramer, PennLine Service

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