Designing a health questionnaire for patients in a contact lens practice is an important step in ensuring the safety of contact lens wear and overall eye health. Here are some important factors to consider when creating a health questionnaire for contact lens patients:

1. Personal Information: Begin with the patient's personal details, such as name, date of birth, contact information, and current address.

2. Health History: Include questions about the patient's overall health history, including existing medical conditions, allergies, or medications they are currently taking. This information can help identify potential risk factors for contact lens wear.

3. Eye Health History: Inquire about the patient's eye health history, including any past or present eye conditions, surgeries, or injuries. Also, include questions about any family history of eye diseases or conditions.

4. Contact Lens History: Include questions about the patient's experience with contact lenses, such how long they have been wearing contacts, the type and brand of lenses they use, and any previous issues or complications related to contact lens wear.

5. Lifestyle and Hab: Ask about the patient's daily habits and lifestyle factors that may impact contact lens wear, such as occupation, hobbies, and environmental factors.

6. Hygiene and Compliance: Include questions about the patient's hygiene practices and compliance with contact lens care instructions, including how often they replace their lenses and their compliance with lens care and cleaning routines.

7. Symptoms and Concerns: Inquire about any current symptoms or concerns related to contact lens wear, such discomfort, redness, dryness, or changes in vision.

8. Additional Considerations: Depending on the specific focus of the contact lens practice, consider adding questions related to specific contact lens modalities, specialized fittings, or any other relevant factors.

It's important to ensure that the health questionnaire complies with relevant privacy and data protection regulations, and that the patient understands the purpose of providing this information. Additionally, the questionnaire should be regularly reviewed and updated to reflect changes in best practices and industry standards.

As an AI, I don't have access to specific templates or official documents from regulatory bodies such as the College of Opticians in Ontario. However, I can provide a general outline for a contact lens patient health questionnaire based on best practices and industry standards. Please customize and verify the following information according to the guidelines provided by the College of Opticians in Ontario:

1. Personal Information

   • Full Name
   • Date of Birth
   • Address
   • Contact Number
   • Email Address

2. Medical History

   • Do you currently have any systemic health conditions? If yes, please specify.
   • Are you currently taking any medications? If yes, please specify.
   • Do you have any known allergies (e.g., medication, latex, etc.)?

. Ocular History

• Have you undergone any eye surgeries or procedures? If yes, please provide details.
• Do you have any history of eye diseases or conditions (e.g., glaucoma, dry eye, etc.)?
• Are there any known ocular allergies or sensitivities?

4. Contact Lens History
   • How long have you been wearing contact lenses?

• What type of contact lenses do you currently wear (e.g., soft, rigid gas permeable)?
  • How often do you replace your contact lenses?
  • Have you experienced any issues with contact lens wear in the past (e.g., discomfort, redness, infections)?

5. Lifestyle and Habits

   • What is your occupation?
   • Do you have any hobbies or activities that may affect contact lens wear (e.g., swimming, outdoor activities)?
   • How frequently do you wear your contact lenses (daily, extended wear, etc.)?
   • Do you regularly adhere to the recommended contact lens care and hygiene practices?

6. Symptoms and Concerns Are you currently experiencing any discomfort or irritation with contact lenses?

   • Have you noticed any changes in your vision or any other ocular symptoms recently?

7. Additional Information

   • Are you interested in trying different types of contact lenses (e.g., multifocal, toric)?
   • Do you have any specific requirements or concerns related to contact lens fitting and wear?

It's important to ensure that the questionnaire is in compliance with the regulations and guidelines set forth by the College of Opticians in Ontario. Additionally, consider including a section for the patient's consent for contact lens fitting and related procedures.