Get Eye Exam Form

Completing the Eye Exam Form online is an essential step in ensuring your child's vision health is documented as required by Illinois law. This guide will provide you with easy-to-follow instructions for successfully filling out the form.

Follow the steps to accurately complete the Eye Exam Form online:

1. Press the ‘Get Form’ button to access the Eye Exam Form and open it in your preferred editor.
2. Fill in the student's name, birth date, sex, and grade in the designated fields.
3. Enter the parent or guardian's name and contact information, including phone number and address.
4. Date of examination should be recorded as specified, along with the ocular and medical history, indicating if the history is normal or positive.
5. Note any drug allergies in the appropriate section, stating if there are none or listing specific allergies.
6. Complete the examination section by filling out the refraction details for each eye and indicating if refraction was performed with cycloplegic agents.
7. For each eye exam component (external exam, internal exam, neurological integrity, etc.), indicate if results are normal, abnormal, or not able to assess.
8. Provide any additional comments or findings in the comments section.
9. Mark the diagnosis based on the outcomes from the examination, selecting options such as normal, myopia, or other conditions.
10. Fill in the recommendations section, indicating if corrective lenses are needed and any additional recommendations for re-examination.
11. Provide the optometrist or physician's printed name and ensure that a signature is acquired for consent from the parent or guardian.
12. After completing all fields, save your changes, and either download, print, or share the form as needed.

Complete and submit your documents online to ensure timely processing.