Vision: Examination Report 2026

1. Click ‘Get Form’ to open the Vision: Examination Report in the editor.
2. Begin by entering the date at the top of the form, followed by the child's name, birth date, sex, grade, phone number, and address. Ensure all personal information is accurate for proper identification.
3. Fill in the county and testing location details along with the testing agency. This information helps in tracking and managing records effectively.
4. Complete the section for parent or guardian details. This includes their name and contact information to ensure they can be reached if necessary.
5. In the 'To Be Completed Following Screening' section, indicate the instruments used for testing and check off any relevant symptoms noted during examination.
6. For 'Reason for Referral', select appropriate options based on visual acuity needs. If applicable, provide additional comments regarding glasses or care under a doctor.
7. Finally, have the examining doctor complete their section by filling out visual acuity results and recommendations before signing off on the report.

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