Kentucky eye examination form for school entry 2025

1. Click ‘Get Form’ to open the Kentucky Eye Examination Form in our editor.
2. Begin by filling out the Identifying Information section. Enter the student's name, date of birth, and parent or guardian's name.
3. Next, provide the Date of Enrollment and Date of Vision Examination. This information is crucial for compliance with school entry requirements.
4. In the Case History section, indicate any ocular history and medical history. Check 'Normal' or 'Positive' as applicable for each item listed.
5. Complete the Refraction details by selecting whether a cycloplegic was used and entering unaided and best-corrected acuity values for both eyes.
6. Fill in the Diagnosis section by checking all that apply, including options like Myopia or Amblyopia.
7. Finally, provide recommendations and ensure that the form is signed with the optometrist's or ophthalmologist's details before submission.

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