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Click ‘Get Form’ to open the eye exam form in the editor.
Begin by entering the identifying information. Fill in the student’s name, date of birth, and parent or guardian's name in the designated fields.
Proceed to the case history section. Enter the date of the exam and indicate any ocular or medical history by checking 'Normal' or providing details for any positive findings.
In the exam section, assess each item such as Amblyopia and Strabismus. Mark 'Normal', 'Abnormal', or 'Not able to assess' as applicable.
Complete the visual acuity measurements for both distance and near vision by filling in the appropriate values for OD (right eye) and OS (left eye).
For refraction, select a diagnosis from options like Myopia or Hyperopia, and provide any additional treatment recommendations as needed.
Finally, fill out payer information and sign off with your name and title before saving your completed form.
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Use the online ZEISS Online Vision Screening1 to check your eyes online. This online vision test was developed by ZEISS experts to allow you to test your eyes in an easy and fast way for free.
How do I submit my vision test to NYS DMV?
MVAs website or self-service kiosk: vision exam results must be submitted electronically by an Authorized Online Vision Certification Provider. Mail-in-renewal: drivers are required to have their vision provider complete the vision certification on the back of their renewal form.
How to document a normal eye exam?
Have at least 20/40 distant visual acuity in either eye, with or without corrective lenses. Have not less than 120 degrees combined horizontal peripheral field of vision. Are able to distinguish the colors red, green and amber.
How do I send my vision test to NY DMV?
You must pass a vision test when you apply for a driver license or to renew your license. The test must show that you have visual acuity of at least 20/40 (based on the Snellen Visual Acuity Scale) in either or both eyes, with or without corrective lenses.
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