Services

Vision

Eye Disease

Latest News

December Blog

November went so fast that I really didn't find the time to write anything.  I'm sure December will go even faster. Last month the office did a promotional mailing to our Medicare patients.  It off...
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October Blog

Well, it has finally begun.  Today we switched over to our new Electronic Medical Records (EMH) software.  Let's just say it wasn't exactly a smooth transition.  When you're used to writing on pape...
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September Blog

The office is moving closer to being paperless.  The hardware is ready to go.  The software is now installed.  Training on using the new electronic medical record software begins this week.  I hop...
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August Blog

If you have Medi-Cal insurance, there is some bad news.  The state has discontinued funding for optometric services for adults.  They will not cover eye examinations, glasses. or medical care. If...
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Economic Stimulus Plan

In an effort to do our part for the lagging economy, we are pleased to offer "The Dr. Steensma Economic Stimulus Plan".  If you buy a second or third pair of glasses at the same time, the second an...
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Patient Medical Information Form

Name:*                                                          Date:* 
Last eye examination:    Last thorough medical exam: 
Do you take any medications?

   List on the next page in Section A
Have you had any major illnesses or injuries?

   List on the next page in Section B
Have you had any eye surgeries?

   List on the next page in Section C
Do you have allergies to any medications?

  

Do you currently have any problems in the following areas?
If needed continue on next page in Section D
Eyes (poor vision, eye pain, tearing, redness, itching, burning, spots) N
 
General/Constitutional (fever, heat stroke, weight loss or gain, unusually tired) N
 
Ears, Nose, Throat (hard of hearing, stuffy nose, ear ache, cough, etc.) N
 
Cardiovascular (high BP, racing pulse, etc.) N
 
Respiratory (congestion, wheezing, shortness of breath, etc.) N
 
Gastrointestinal (stomach upset, diarrhea, constipation, ulcers, etc.) N
 
Genital, Kidney, Bladder (painful/frequent urination, yellow jaundice, etc.) N
 
Females (Are you pregnant? Nursing?) N
 
Muscles, Bones, Joints (joint pain, stiffness, swelling, cramps, arthritis, etc) N
 
Skin (warts, growths, rash, skin cancer, etc.) N
 
Neurological (numbness, headache, seizures, paralysis, etc.) N
 
Psychiatric (anxiety, depression, insomnia) N
 
Endocrine (diabetes, hypothyroid, etc.) N
 
Allergic / Immunologic (sneezing, swelling, redness, itching, hives, lupus, etc.) N
 
Has any member of your family had these diseases (check all that apply)? And who?
Macular Degeneration 
Glaucoma 
Ever have a blood transfusion?


Do you drink alcohol?


Do you use illicit drugs?


Do you smoke?


Does your vision limit any activities of daily living?


Patient signs:*  Doctor signs: ________________________
 
Section A - Medication List
Medication Why Taken Medicaton Why Taken
 
Section B - Major Illnesses & Injuries
 
Section C - Eye Surgery History
 
Section D - Other Current Health Problems