Sq 214 353 2026

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Le document est un rapport d'examen visuel qui doit être rempli par le candidat et l'ophtalmologiste ou optométriste. Il comprend des sections pour l'identification du candidat, les résultats de l'examen visuel (acuité visuelle, champs visuels, motilité oculaire, vision binoculaire et perception des couleurs), ainsi que des commentaires sur d'éventuelles anomalies. Le rapport est valide pour un an à partir de la date de l'examen.

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Click ‘Get Form’ to open the sq 214 353 document in the editor.
Begin by filling out Section 1, which requires your identification details. Enter your name, date of birth, address, city, province, and postal code. Indicate if you have undergone vision correction surgery by selecting 'Yes' or 'No'. If applicable, ensure to attach the supplementary report from your ophthalmologist.
Proceed to sign and date this section at the bottom.
Move on to Sections 2 and 3 for the ophthalmologist or optometrist to complete. They will assess visual acuity using metrics and fill in details regarding eye health. Ensure they provide their identification and signature as well.
Review all entries for accuracy before saving or exporting the completed form directly from our platform.

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Versions	Form popularity	Fillable & printable
2017	4.7 Satisfied (27 Votes)
2012	4.9 Satisfied (57 Votes)

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