Get Eye Exam Form Final.docx - Vvsd

Completing the EYE EXAM FORM FINAL.docx - Vvsd is essential for ensuring that a child's vision needs are met for their educational journey. This guide will assist you in filling out the form accurately and efficiently online.

Follow the steps to complete the eye exam form online.

1. Click the ‘Get Form’ button to access the eye exam form and open it in your online editor.
2. Fill in the student's name in the designated fields: Last, First, and Middle Initial.
3. Enter the student's birth date, including Month, Day, and Year.
4. Indicate the student's gender and grade.
5. Provide the name, phone number, and address of the parent or guardian, including the Zip Code and County.
6. The examining doctor should complete the case history section, including the date of the exam and any positive ocular or medical history.
7. Indicate drug allergies if any, and fill in the exam results for both distance and near visual acuity for the right, left, and both eyes.
8. Answer whether refraction was performed with dilation by selecting 'Yes' or 'No'.
9. Complete the various assessments such as external and internal exams, and provide any comments if unable to assess.
10. Select the diagnosis from the provided options and write any other conditions in the specified space.
11. Provide recommendations, including whether corrective lenses are suggested and any need for preferential seating or re-examination.
12. The examining doctor should print their name, indicate their license number, and select their title (MD, OD, DO).
13. Obtain the consent of the parent or guardian by having them sign and date the form.

Start filling out your eye exam form online today!