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Page 1: Dr. Shelly Taneja, Optometrist - The Brass Monoclebrassmonocle.com/wp-content/uploads/2016/09/Patient_Intake_Form.pdf · PERSONAL EYE HISTORY Reason for today's visit: Do you wear

Alberta Health Care

Dr Shelly Taneja &

Dr. Shelly Taneja, Optometrist

mm/dd/year

Brass Monocle

Page 2: Dr. Shelly Taneja, Optometrist - The Brass Monoclebrassmonocle.com/wp-content/uploads/2016/09/Patient_Intake_Form.pdf · PERSONAL EYE HISTORY Reason for today's visit: Do you wear

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OS GRADERS OF20. manan chugh lalit chugh binny budhiraja 21. myra bharti abhishek bharti shelly 22. naksh sareen ajay sareen prerna bhatia 23. panav taneja tilak raj taneja ritika

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