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Rapport d'examen visuel SQ-214-353 2026
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- Click ‘Get Form’ to open the Rapport d'examen visuel SQ-214-353 in the editor.
- Begin with Section 1, where you will fill in your personal identification details. Enter your name, date of birth, address, and postal code. Indicate if you have undergone vision correction surgery by selecting 'Yes' or 'No'. If applicable, ensure to attach the supplementary form completed by your ophthalmologist.
- Proceed to sign and date this section at the bottom.
- Move on to Sections 2 and 3, which must be filled out by an ophthalmologist or optometrist. In Section 2, they will assess visual acuity using the Snellen chart and document findings for each eye. Ensure they check for visual fields and any ocular motility anomalies.
- In Section 3, the ophthalmologist or optometrist should provide their identification details, including their name, address, license number, specialty, and signature along with the examination date.
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