Get Eye Exam Form - Champaign Unit 4 Schools - Champaignschools

This guide will help you navigate the Eye Exam Form required by the Champaign Unit 4 Schools. Complete the form accurately to ensure proper documentation of your child's eye examination.

Follow the steps to complete the Eye Exam Form online.

1. Press the ‘Get Form’ button to access the Eye Exam Form online and open it in your document editor.
2. Fill out the student's personal information at the top of the form, including their full name, birth date, sex, and grade level.
3. Provide the parent or guardian's details, including their full name, phone number, and address. Ensure accuracy for correspondence purposes.
4. Complete the case history section by indicating the date of the eye exam and providing any relevant ocular or medical history, including drug allergies.
5. After the examination, the examining doctor will need to fill out sections related to the eye examination results, including both visual acuity measures and other assessments. Review these results carefully.
6. If any diagnoses are made, such as myopia or astigmatism, ensure these are marked correctly as per the doctor's findings.
7. In the recommendations section, check the appropriate boxes for corrective lenses, preferential seating, and re-examination timelines.
8. The eye care provider should sign and date the form. Ensure that this signature and date are completed to validate the examination.
9. Lastly, as a parent or guardian, provide your consent by signing the form to authorize the release of your child's information to the school.
10. Once all required fields are completed and verified, save your changes, download a copy for your records, and share or print the form as needed.

Complete your Eye Exam Form online today to ensure your child's vision needs are met promptly.