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Online Eye Health Consultation
Online Eye Health Consultation
Personal Data
Name
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*
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ID / Passport photograph
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Patient data
Who is the patient?
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Myself
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Name
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ID/Passport photograph
Please attach a copy of the patient's identity card. In case the patient is a minor, you must also attach the document that certifies you as the legal guardian.
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Birth date
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Sex
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Medical / Ophthalmological data
What is the reason of your consultation at IMO?
*
Is this your first visit at IMO?
*
Yes, this is my first visit at IMO
No, I am a current patient at IMO
General medical history (non ophthalmological)
Please complete the following questionnaire with all information you know
Do you have any known allergy?
Yes
No
What are you allergic to?
Do you have a high blood pressure?
Yes
No
What medication are you taking?
Are you diabetic (high sugar levels)?
Yes
No
How long have you been diabetic for? What medication are you taking?
Do you have heart problems?
Yes
No
What kind of problems? Are you taking any medication? What medication?
Do you take anticoagulants or antiaggregant?
Yes
No
What kind of medication?
Do you have high cholesterol?
Yes
No
What medication are you taking?
Do you have thyroid problems?
Yes
No
What medication are you taking?
Do you have respiratory problems such as chronic bronchitis or asthma?
Yes
No
What problem and what medication do you take?
Any other medical problems or current treatment? If yes, have you had any surgical procedures previously, which ones and why?
¿Te han realizado cirugías previamente? ¿Cuáles y por qué motivo?
Ophthalmologic history
Please complete the following questionnaire with the information you know
Have you ever had laser surgeries or procedures, injections, etc., in your eyes?
Yes
No
Please indicate which procedures, in which eye, and the approximate date?
Do you put on or do you take some medication for an eye problem?
Yes
No
Could you tell us why you are taking the treatment and what treatment it is?
Which eye are you having the treatment on?
Do you know your current level of vision?
Sí
No
What is approximately your current vision?
In case of wearing glasses or contact lenses, do you know your approximate graduation?
Yes
No
If your answer is yes, what is the graduation of both eyes?
Invoicing details
Name and surname or company
Address
Postcode
Place
Community/Area
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Reports
You can send us old evidence as additional information, but we advise you to add evidence with a recent date (preferably not more than 30 days), since we cannot guarantee a reliable orientation based on older evidence.
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Doctor with whom you desire the consultation
- None -
Any
Dra. Elena Arrondo
Dra. Miriam Barbany
Dr. Borja Corcóstegui
Dr. Daniel Elies
Dr. José García-Arumí
Dr. Óscar Gris
Dr. José Luis Güell
Dr. Carlos Mateo
Dr. Ramón Medel
Dr. Rafael Navarro
Dra. Esther Pomares
Dra. Cecilia Salinas
Dra. Luz María Vásquez
Dr. José Visa
Dra. Ana Wert
Dra. Charlotte Wolley Dod
Dra. Susana Perucho
Dr. Marco Sales
Dr. José María Ruiz Moreno
Dra. Andrea Oleñik
Dr. Natalino Giuliano
Dr. Jorge Cazal
Dra. M. Teresa Iradier
Dr. Diego Celdrán
Dr. Jorge Ruiz Medrano
Dr. David Mingo
Dra. Lucía González
I have read and accept the
informed consent document for ophthalmic video consultation at IMO
*
I have read and accept the informed consent document for ophthalmic video consultation at IMO
*
I have read and accept the
privacy policy
and the
cancellation policy
*
He leído y acepto la política de privacidad y la política de cancelación
*
Price of consultation
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Eye diseases
Ophthalmic subspecialities
Cornea
Cataract
Refractive
Retina and vitreous
Glaucoma
Pediatric ophthalmology
Strabismus in adulthood
Oculoplastic surgery
Aesthetics and oculofacial rejuvenation
Disorders
Treatments
FAQ
Medical team
Human team
Doctors and departments
Other areas
Facilities and services
Consulting rooms
Molecular biology laboratory
Dry Eye
Operating theatres
Emergency Room
Our medical team
Guides and tips
IMO Cares
Eye health tips
Risk groups
Prevention
How can vision problems be prevented?
Your visit and your surgery
Before my visit
Before my surgery
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