Dizzy and blurred vision spells
[DOCX File]ILLINOIS OCULOPLASTIC ASSOCIATES, S.C. - HOME
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☐ Blurred Vision – Distance ☐ Blurred Vision – Near ☐ Burning Eyes ☐ Cataracts ☐ Color Vision, Poor ☐ Crossed Eyes ☐ Dizzy Spells ☐ Double Vision ☐ Droopy Eyelids ☐ Dry Eyes ☐ Eye Infection Eye Injury ☐ Eye Strain ☐ Fainting spells…
[DOC File]CONSULTANTS IN UROLOGY, PA a division of Premier …
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Blurred Vision Yes No. Double Vision Yes No. Pain Yes No. Other _____ Allergic/Immunologic. Hay Fever Yes No ... Other _____ Neurological. Tremors Yes No. Dizzy Spells Yes No. …
[DOCX File]Buteyko Clinic International - Breathing Method ...
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Blurred vision. Dizzy Spells. Confusion, losing contact with reality. Fast or deep breathing. Shortness of breath . Tightness in the chest . Bloated Feelings in Stomach . Tingling of fingers …
[DOC File]PLEASE CIRCLE ANY OF THE FOLLOWING IF YOU HAVE HAD …
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Blurred or double vision Lightheaded or dizzy. Spells of blindness of either eye Convulsions or seizures. Numbness or tingling. Hearing loss or ringing Tremors. Chronic sinus problems …
[DOC File]PATIENT HISTORY FORM
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Dizzy spells. Numbness/tingling Y Y Y N. N. N Urine retention. Painful urination. Urinary frequency Y Y Y N. N. N Other _____ Other _____ Endocrine Respiratory Excessive thirst. …
[DOCX File]ADULT PATIENT REGISTRATION FORM - Urologic …
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Blurred vision Yes NoJoint pain Yes No. Double vision Yes NoNeck pain Yes No. Pain Yes NoBack pain Yes No. OtherOther. Allergic/Immunologic ... Neurological. Genitourinary. Tremors Yes NoUrine retention Yes No. Dizzy spells …
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