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P A T I E N T / E Y E C A R E P R O F E S S I O N A L I N F O R M A T I O N
Next Appointment:
Date:
Dr.:
Address:
Phone:
Day Date Hours Worn Day Date Hours Worn
1 1
2 2
3 3
4 4
5 5
6 6
7 7
IMPORTANT: In the event that you experience any difficulty wearing your lenses or you do not understand
the instructions given you, DO NOT WAIT for your next appointment. TELEPHONE YOUR EYE CARE
PROFESSIONAL IMMEDIATELY.
83889_Galy.Sept 4/10/06 3:56 PM Page 19