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Dear Patients, Entrance to Our Practice is From Our Outside Door, Just to the Right of the Home and Pharmacy Entrance of Walmart

Sorry for any inconvenience

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Home » Directions to Our Olathe Eye Doctor » Contact Us » Patient Medical History

Patient Medical History

Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office.



This form contains confidential information and is delivered to your doctor through a secure Internet connection.