Pink Eye

When did you first notice your pink eye?

Are you experiencing symptoms in one eye or both?



Are you currently having, or have you recently had, any upper respiratory symptoms?

Have you noticed any discharge?




Have you recently been diagnosed with an ear infection?

Does your pink eye occur seasonally when pollen counts are high?




Do any of the following conditions apply to you?





Do you use contact lenses?

Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?

Do you have a preferred medication?





Would you like to share anything else with your provider through an upload?

Cancel Visit

Do you want to cancel the visit?


Cancel Visit

Do you want to cancel the visit?