Stahl Vision has been providing a wide range of vision care services to the Dayton area for over 20 years!
Stahl Vision4235 Indian Ripple Rd, Dayton, OH
Please mark Yes or No, provied any Yes answer in deignated area below
Currently Pregnant or Nursing
Auto Immune Deisease (Lupus, Sarcoid, Wegener's, Fibromyalgia, Rheumatorid)
Infectious Disease (HIV, Hepatitis)
History of Cold Sores or Herpes
Depression / Anxiety Disorders
Skin Disorders (specify below)
Adult Acne (acne rosacea)
Arthritis (specify below)
Keloids or Excessive Scarring
Allergies or Severe Hayfever
Have you taken any of these medicines: Accutane, Imitrex, Cordarone
List any other major medical problems
What do you use most of the time for distance vision?
When was the last time you had contacts in?
Types of contacts?
Have you quit wearing contacts because of problems wearing them?
If you are 40 or over, what do you currently do for reading (you may select more than one):
take glasses off
Very dry eyes
Poor night vision
Prescription keeps changing a lot
Lazy eye or muscle surgery
Eyelash infections or styes
Family history of eye problems
Prior eye surgery
Eye inflammation (iritis, episcleritis)
Any other eye diseases / infections
List details for any yes answers: