A Guide for Vision Testing - Health Services & School Nursing 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date at the top of the form. This helps keep track of when the vision screening referral was made.
3. Fill in the subject line with your child's name, ensuring that all relevant parties can easily identify the document.
4. In section 1, check the appropriate box based on your child's vision assessment results. If a complete examination is needed, select that option.
5. Provide contact information for scheduling an appointment in section 2. This ensures parents know where to call for further action.
6. In section 4, record the screening results for distance and near vision. Be sure to include both eyes' measurements accurately.
7. For optometry clinic information, fill out sections regarding vision without glasses and ocular health as provided by the examining physician.

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