Illinois school eye exam form 2021-2026

1. Click ‘Get Form’ to open the Illinois School Eye Exam Form 2021 in our editor.
2. Begin by entering the student's name, birth date, sex, and grade in the designated fields at the top of the form.
3. Fill in the parent or guardian's name, phone number, and address. Ensure all information is accurate for school records.
4. In the 'Case History' section, input the date of examination and complete any ocular or medical history as required by your examining doctor.
5. Proceed to fill out the examination results including visual acuity for both distance and near vision. Indicate if refraction was performed with cycloplegic agents.
6. Complete the diagnosis section by checking applicable conditions such as myopia or astigmatism.
7. In the recommendations section, indicate if corrective lenses are needed and provide any additional comments as necessary.
8. Finally, ensure that both the optometrist's/physician's signature and parent/guardian consent are completed before submitting.

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