Macular Degeneration Appointment Preparation Checklist Form
Prepare for your macular degeneration appointment by completing this essential checklist. Ensure you are ready for your visit by following each step.
Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Bring a list of all current medications
I will bring an up-to-date list of all my current medications
Bring any previous eye test results or reports
I will bring previous eye test results or reports
Arrange for a companion or transportation if your vision may be affected by the exam
I have arranged for a companion or transportation if needed
Wear comfortable clothing for the appointment
I will wear comfortable clothing
Bring your current glasses or contact lenses
I will bring my current glasses or contact lenses
Bring a list of any symptoms or vision changes
I will bring a list of any symptoms or vision changes
Bring your insurance information (if applicable)
I will bring my insurance information (if applicable)
Plan to arrive at least 15 minutes before your appointment
I plan to arrive at least 15 minutes early
Prepare any questions you have for your eye care provider
I have prepared questions for my eye care provider
Submit Checklist
Should be Empty: