Atlanta Oculofacial Plastic Surgeons Logo mark Atlanta Oculofacial Plastic Surgeons Logo

Address: 755 Mount Vernon Highway, NE
Suite 210
Atlanta, GA 30328
Telephone: 404-480-4008
Fax: 404-480-4007

Patient Medical History





Patient Information









Current Medications: Include prescription, over the counter, vitamins and supplements


Current Ocular Medications:


Patient Medical History:


Surgical History



Allergies to Medications


Latex Allergy

  
  

  
  

  
  

  
  

  
  

  
  

  
  


Family History

Afflicted Family Member








Afflicted Family Member










Social History:

Smoking

Alcohol

Marital Status

Substance Abuse

Occupation







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