THE MACULAR
DEGENERATION COMMUNITY

Name
FULL NAME

Born
BIRTHDAY

Home
HOME

Diagnosis
DIAGNOSIS

Eyes Affected
EYES

Eye Color
COLOR

Age at Diagnosis
AGE

Acuity
ACUITY

Treatment
TREATMENT

Prognosis
PROGNOSIS

Family History
HISTORY

Impact On Your Life
IMPACT

Positive Effects
EFFECTS

Adaptations
ADAPTATIONS

Employment
EMPLOYMENT

More About Me
MORE