Sheldon H Kreda, OD, PA Telehealth Medical Examination Form
Guardian Name - if the patient is younger than the age of 18.
Street Address Line 2
State / Province
Postal / Zip Code
Please be careful that uploaded photos are clear.
Photo Upload 1 - Close Up Photo of Your Condition
Photo Upload 2 - Far Photo of Your Condition
Please state the details of your condition
I authorize Dr. Sheldon H. Kreda, OD, FAAO to provide an Optometric consultation and agree to pay any co-pay, deductible or consultation fee.
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