New York Eye and Ear Infirmary
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"My Medication List" for Patients


Although one can simply print out any given form as is and then fill it out by hand, we encourage users to fill out the form using their computer so the form will be easier to read when processed. For help with filling out forms online, view our tutorial.


To view these forms you must have the free Adobe Acrobat Reader. If you do not have it, download the most recent version from Adobe's website.

My Medication ListMy Medication List - ENGLISH
(PDF - 124 KB)

My Medication List - SPANISH
(PDF - 132 KB)

My Medication List - RUSSIAN
(PDF - 194 KB)

My Medication List - CHINESE
(PDF - 264 KB)


Questions about "My Medication List"?

If you have any questions about "My Medication List", please contact your NYEE doctor's office.




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