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:



Marital Status

Substance Abuse


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