Follow the steps to complete your EyeScreen Examination form online.

1. Press the ‘Get Form’ button to access the EyeScreen Photographic Examination form and open it in your selected platform.
2. Read through the information provided about the EyeScreen procedure carefully. This section explains the importance of retinal health evaluation and the benefits of the EyeScreen photograph.
3. Locate the agreement section where you will need to select one of the following options regarding your participation in the EyeScreen procedure: 'I AGREE to have my retinal health evaluated with the EyeScreen photograph for $20' or 'I DO NOT wish to have the EyeScreen photograph.' Make your selection by clicking on the appropriate box.
4. Next, find the signature field. Enter your name or, if you are a parent or guardian signing for a minor, include the signature of the responsible adult.
5. Complete the date field by entering the appropriate date of filling out the form.
6. Once all fields are filled out, you can save your changes, download the completed form, print it, or share it as needed.

Complete your EyeScreen Photographic Examination form online today to ensure optimal retinal health.