Skip to main content
twitter
facebook
instagram
About
Blog
Hearing Care
0% Finance
Contact Us
Book an Appointment
Hit enter to search or ESC to close
Close Search
search
Menu
Home
Eye Examination
Contact Lenses
eyeQ Care Plans
Eyewear
Specialist Services
Children & Teenagers
search
First Name
*
Last Name
*
Date of Birth
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Patient ID (TKS Staff Only)
Eye History
(Patching as a child/Accidents/Hospital Visit. Have you previously tried contact lenses, what have you tried/when) Lipiflow /IPL
Medications
(List all, prescribed and over the counter e.g Contraceptive Pill or Anti-histamines)
Allergies to Medicines
Eye Prescriptions
(Any current eye drops being used or tablets being taken to help eye conditions)
Eye Family History
Parents/Siblings/Children - any conditions such as Glaucoma, Macula Degeneration, Blindness, Myopia (short sighted), Strabismus (‘squint/caste’) Keratoconus
Eye Operations
(Such as cataract surgery, laser surgery, retinal or lid surgery)
Social History
Do you smoke or drink? - How much/Often? Hobbies? Sports?
Medical History
Do you or a close family member suffer from general (systemic) health conditions such as blood pressure, cholesterol, thyroid. For kids, were they Full Term and healthy baby (no long spell in hospital)
Contact Lens History
Close Menu
Home
Eye Examination
Contact Lenses
eyeQ Care Plans
Eyewear
Specialist Services
Children & Teenagers
About
Blog
Hearing Care
0% Finance
Contact Us
Book an Appointment
twitter
facebook
instagram
Call Now
Directions