
9410 20th Avenue Edmonton Alberta Canada T6N 0A4 Tel 780 437-9100 / Fax 780 437-7787 EYE EXAMINATION REPORT AB-95 2005-02 Personal Information please print Name Last First middle Address Apt. /Street Phone Number City Province Postal Code E-Mail Address Vision requirements Evidence of satisfactory vision as determined by a professional recognized person i*e* Oculist Optometrist Ophthalmologist Medical Doctor or Registered Nurse no more than one 1 year prior to the date of submission to ABSA. a Distant vision shall equal 20/30 or better in at least one eye either uncorrected or corrected* b Near vision acuity shall permit reading 0. 5 m continuous text N-4 at a 40 cm test distance with their habitual correction one or both eyes. The following are considered equivalent to the 0. 5 m performance Times Roman N-4 at 40 cm Reduced Snellen 40/50 Jaeger J2 at 40 cm 0. 5 m at 40 cm 0. 37 m at 30 cm To be completed by Eye Examiner I certify the person named above please check Meets Without corre....
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How to fill out the Ab 95 Absa Form online
Filling out the Ab 95 Absa Form online can be a straightforward process when you follow the right steps. This guide provides detailed instructions to help you complete the form correctly and efficiently.
Follow the steps to fill out the Ab 95 Absa Form online.
- Use the ‘Get Form’ button to access the Ab 95 Absa Form and open it in your chosen editor.
- Start by filling in your personal information. Provide your name, including last name, first name, and middle name as requested. Then, include your complete address with apartment or street details, phone number, city, province, and postal code. Lastly, enter your email address.
- In the vision requirements section, you will need to indicate evidence of satisfactory vision as determined by a professional. Ensure that this evidence is dated within one year of the submission. Specify whether your distant vision meets the required standards (20/30 or better) in at least one eye, and confirm your near vision acuity.
- The eye examiner must complete their section by checking whether you meet the vision requirements with or without correction. The examiner should also select their professional designation from the provided options (ocularist, optometrist, ophthalmologist, medical doctor, or registered nurse).
- Have the eye examiner print their name, sign the document, and provide their phone number along with the examination date.
- Review the entire form to ensure all sections are filled out accurately. Once you are satisfied, you can save any changes, download the completed form, print it, or share it as needed.
Complete the Ab 95 Absa Form online today for a seamless submission experience.
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