Get Optometry Exam Form

Filling out the Optometry Exam Form online is an essential step in ensuring that your child's vision is assessed before school enrollment. This guide provides clear, step-by-step instructions to assist you in accurately completing the form.

Follow the steps to fill out the Optometry Exam Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling out the identifying information section. Include the student's full name, date of birth, and the parent or guardian's name.
3. Record the date of the exam in the case history section. Also, indicate if there are any positive findings in ocular and medical history.
4. List any drug allergies under the relevant section, noting if the individual has no known drug allergies or if they have specific allergies.
5. In the family ocular and medical history section, indicate any relevant conditions such as amblyopia, strabismus, or diabetes.
6. Fill out the refraction details, including unaided and best corrected acuity for both eyes, marking if the results are normal, abnormal, or not able to assess.
7. Provide a diagnosis based on the examination findings, selecting all applicable conditions such as myopia or hyperopia.
8. Include recommendations, specifying if glasses are prescribed and any additional guidance as necessary.
9. Finally, sign and date the form, entering the optometrist or ophthalmologist's name, address, and telephone number.
10. Once completed, you can save changes, download, print, or share the form as needed.

Complete the Optometry Exam Form online to ensure your child's vision is properly assessed before school.