Durrie Vision, PA 8300 College Blvd - Suite 201 - Overland Park KS 66210 Phone - (913) 491-3330 Fax - (913) 491-9650 Continued on Back . Health History Name: _____ Date: _____ Medication History Please list all medications you are currently taking: ... Patient Allergies Please list all medications you are allergic to: ....