Kentucky eye examination form for school entry 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Identifying Information section. Enter the Student Name, Date of Birth, and Parent or Guardian Name accurately.
3. In the Case History section, provide the Date of Exam and detail any Ocular History. Indicate if there are any medical issues or drug allergies present.
4. Complete the Refraction section by indicating whether a cycloplegic was used and filling in Unaided Acuity and Best Corrected Acuity fields.
5. For the Diagnosis section, check all applicable conditions such as Myopia or Hyperopia, and provide recommendations based on the examination results.
6. Finally, ensure that the form is signed and dated by an Optometrist or Ophthalmologist before submission.

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