1715 S. Wells Ave. Meridian, Idaho 83642

Lifestyle Index Form

  • This questionnaire is meant to help your doctor understand what you're experiencing on a regular basis— whether it's caused by your eyes, posture,stress, etc. Your responses will help make sure you receive the best care possible. How often do you experience any of these symptoms? Choose the applicable answer.
  • Any additional notes you'd like to add
  • This field is for validation purposes and should be left unchanged.