New Patient Info

Health History Form

Northeast Ohio Eye Surgery's Health History Form is filled out by all of our new patients and all patients that have not been to our office in over two years. For your convenience we are providing you with a blank Health History Form (see below) that you can download, print and fill out at home, thus saving you time on your visit to our facility.

To view the PDF file you will need the PDF Reader software (otherwise known as the Adobe Reader) installed on your computer. If you do not have PDF reader software, visit www.adobe.com to download a free version.

The form is provided for you in both a Portable Document
Format (PDF) and a Microsoft Word format.

Health History Form (PDF)
Health History Form (MS WORD)