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Eye Drop Schedule

Setup Schedule


Times:

MY EYE DROPS

Use this schedule to track your daily medications.

Date Printed

Instructions

  • Wash your hands before applying drops.
  • Wait 5 minutes between different drops.
  • Shake bottle before use if instructed by your pharmacist.
Medication
Morning
Noon
Evening
Bedtime

No drops added yet.

Use the form above to add medications.

Next Appointment: __________________________
Doctor's Signature: __________________________