This document appears to be a medical form collecting information from a patient for an eye exam. It requests the patient's rank, name, age, contact information, and answers questions about their eye health history including their last eye exam, if they wear glasses or contacts, and any existing eye conditions or family medical history of eye diseases. It also asks about their occupation, computer use, current medications, and overall health conditions. The purpose is to gather relevant information on the patient's eye health and medical background to inform their eye exam.