Get Eye Exam Form

Filling out the Eye Exam Form online is a straightforward process that helps ensure accuracy and convenience. This guide provides clear instructions for each section of the form, making it easy for you to complete it effectively.

Follow the steps to accurately fill out the Eye Exam Form online.

1. Click ‘Get Form’ button to obtain the Eye Exam Form and open it in your preferred online editor.
2. Begin with the identifying information section. Fill in the student's name, date of birth, and the name of the parent or guardian. Ensure that all information is accurate.
3. In the case history section, enter the date of the exam. Indicate ocular history by selecting either 'Normal' or 'Positive' and provide any relevant details.
4. For medical history, similarly indicate 'Normal' or 'Positive' and note any significant conditions or issues.
5. Document any drug allergies. If there are none, check the box for 'NKDA' (No Known Drug Allergies). If there are allergies, specify them clearly.
6. Provide family ocular and medical history. Select any relevant conditions and explain as necessary.
7. Complete the exam section by marking 'Normal' or 'Abnormal' for the specified tests. If a particular aspect could not be assessed, make a note of that too.
8. Fill in the visual acuity measurements for both distance and near vision. Follow the format provided in the form.
9. In the refraction section, record the results for both eyes (OD and OS). Make sure to follow the prompts accurately.
10. Select the diagnosis from the options given. If there are additional notes, include them in the space provided.
11. Indicate any treatment recommendations, including whether glasses are prescribed and the wearing instructions.
12. In the payer section, select the appropriate method of payment, whether it's insurance, Medicaid, or another form.
13. Final step: Review all entries for accuracy. Once confirmed, save any changes and choose to download, print, or share the completed form as needed.

Start filling out the Eye Exam Form online today to ensure your child's vision needs are met efficiently.