Fill Out The Patient History Form

Please download the appropriate forms below and open with Adobe Reader (If you do not have Adobe free PDF reader software, please click on the link below to download and install the most current version.) If you are not familiar with downloading and working with Adobe Acrobat Reader, please click on the link for a quick tutorial: How to open and save fillable PDF documents.

When you are finished filling out the form in Adobe Reader, you have three options:

1) You can save on your computer as a PDF file which can be kept for later use and attached to an email.


    pellegrino.vision@gmail.com for Whitby

    pellegrino.vision2@gmail.com for Oshawa


2) Click on the button to submit the form by email or send it directly to our office by email to be added to your file.


3) You can also print the form in Adobe by clicking the Print button at the bottom of the form and bring it with you for your next appointment and save time at the office.

 

Can’t view the file or don’t have a PDF viewer? Download the latest version of Adobe here.

Get Adobe Reader

Click here to quickly search any medication names.