Questionnaire prior to Flow 2.0 eye procedure

Personal data sheet

1.Full name:(Required.)
2.Sex:(Required.)
3.Age:(Required.)
4.Personal code:(Required.)
5.Your profession:(Required.)
6.Hobbies:(Required.)
7.Do you wear contact lenses?(Required.)
8.How frequently do you wear contact lenses?(Required.)
9.Have you ever experienced any of the following problems with your eyes? (You may choose multiple answers)(Required.)
10.Have you had any eye traumas (injury/scarring)? If so, please specify, what and when it was:(Required.)
11.Have you ever experienced any of the following symptoms in your eyes? (You may choose multiple answers)(Required.)
12.Have any of your close relatives had a serious eye condition?(Required.)
13.Do you have any conditions or problems we should be aware of? If so, please specify:(Required.)
14.Have you received any vaccinations during the past two years? If so, which vaccines did you receive?(Required.)
15.Have you undergone any surgeries in the past year? If so, please specify:(Required.)
16.Have you ever had any of the following? (You may choose multiple answers)(Required.)
17.Do you have any allergies or hypersensitivity to any medications? If so, please specify:(Required.)
18.Do you use any of the following medications? (You may choose multiple answers)(Required.)
19.Do you confirm the accuracy of the above information and consent to the processing of your personal data?(Required.)