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(832) 251-7709
Conveniently located next to Papa John's, Subway, & Walmart

CARING FOR
THE EYES OF TEXAS

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New Patient Form

  • Add a new row
  • GENERAL HEALTH

  • EYE HISTORY

  • (WITHOUT CORRECTION)
    YesNo
    Blurry Vision at Distance
    Blurry Vision Close-Up
    "Halos" Around Lights
    Poor Night Vision
    Poor Color Vision
    Flashes of Light
    Dry Eye
    Seeing Double
    Floaters or spots
    Frequent Headaches
    Watering Eyes
  • Add a new row
  • MedicationCondition 
    Add a new row
  • (If someone other than self)
  • Signature of Patient or Parent/Guardian
  • Signature of Patient or Parent/Guardian
  • Signature of Patient or Parent/Guardian
  • Signature of Patient or Parent/Guardian
  • Signature of Patient or Parent/Guardian
Book Appointment ▸ Click to Call (832) 251-7709 ▸ Take Me There ▸

Welcome to Texas State Optical Spring Klein

 
Appointment Form
Call (832) 251-7709 ▸
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Our Location

21195 Kuykendahl Rd
Spring, TX 77379

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