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'Patient Questionnaire - Vaughan
Your answers will help us understand your medical and eye health history, which is important for your eye exam appointment. Thank you!
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* Indicates required question
Email
*
Your email
Patient Full Name (Legal Name on OHIP card)
(名稱)
*
Your answer
Preferred Name
Your answer
My sex assigned at birth
Male
Female
Other:
Clear selection
My pronouns are
He/ him/ his/ himself
She/ her/ hers/ herself
They/ them/ theirs/ themself
Other:
Clear selection
Ontario Health Card Number
(健康卡 號碼)
Your answer
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