VISITS TO HEALTH PROFESSIONAL WITHIN LAST 3 YEARS List all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. List visits for counseling only if related to a personal substance abuse or psychiatric condition. Enter the date of visit as month and year (e.g., 01/1950), name, address, and type of health professional consulted and briefly state reason for consultation. Click the "Add" button. The visit information will display below the appropriate column headings. Repeat this process to add all relevant visits to medical professionals in the past 3 years. Each visit's information can be updated or deleted by clicking on the "Edit" or "Delete" link displayed to the right of each visit listed. Multiple visits to one health professional for the same condition may be aggregated on one line. Routine dental, eye, and FAA periodic medical examinations and consultations with your employer-sponsored employee assistance program (EAP) may be excluded unless the consultations were for substance abuse or unless the consultations resulted in referral for psychiatric evaluation or treatment.