Patient Forms
Please take a few moments to print and fill out the forms below, as it will save time on your behalf before arriving at Eye Physicians of Long Beach for your scheduled appointment. If you have any questions regarding any of the information on the forms, please do not hesitate to contact us at 562-421-2757 or ask us when you arrive for your appointment.
Amsler Grid
The Amsler grid is a grid with horizontal and vertical lines used to monitor the central vision of patients with macular degeneration.
- Make sure you have good lighting
- While wearing your glasses (if you normally wear them to read), hold the grid about 14 inches in front of you
- Cover one eye and look at the center dot with the other eye
- While looking at the center dot, evaluate the appearance of the grid. Do any of the lines look wavy, distorted, blurry or dark? Are any parts of the grid missing or have decreased contrast? If so contact your ophthalmologist immediately
- Do the same with the other eye while wearing your glasses, and cover the eye you just tested
