Follow the steps to complete the form successfully.

1. Press the 'Get Form' button to access the form and open it for editing.
2. In the first section, enter the applicant's name, including last name, first name, and middle initial.
3. Provide the applicant's Social Security Number (SSN) in the designated field.
4. Fill in the date of the examination using the format YYYYMMDD.
5. Input the address of the facility where the examination took place, ensuring to include the city, state, and ZIP code.
6. Enter the telephone number of the facility, including the area code.
7. Indicate the contact lens data by checking the applicable boxes. Report whether soft or hard contact lenses were removed before the examination.
8. Complete the family eye history section by checking any applicable family members who wear glasses or contact lenses.
9. Proceed to the vision evaluation section before cycloplegia. Fill in the distant vision and current prescription for each eye, including od (right eye) and os (left eye).
10. List the medication used for cycloplegic in the designated section.
11. Complete the vision evaluation section after cycloplegia is obtained, ensuring to record any missed letters on the vision chart correctly.
12. Provide remarks if there are any diagnoses that interfere with visual function noted during the examination.
13. Type or print the name of the examiner in the specified field and obtain their signature.
14. Review all fields for accuracy, save any changes, and prepare to download, print, or share the completed form.

Take the next step in your military application process by efficiently filling out and submitting your documents online.