FILL IN OUR

QUESTIONNAIRE FORM

Congratulations on taking the first step towards maximising your visual function and processing skills. Your upcoming appointment will involve more tests than a standard optometric exam. We ask every new patient to complete a questionnaire form so we can spend more time testing. This helps us form your case history and prepare your comprehensive visual report. Take your time to answer these questions carefully.

If you are unsure which questionnaire form to fill out, please give us a call so one of our staff members can help you.

• Infant Toddler Questionnaire

• Child Questionnaire

• Special Needs Questionnaire (Child)

• Adult Questionnaire

• Extensive Adult Questionnaire (for adults with moderate to severe visual concerns)

• Child Strabismus Questionnaire

• Adult Strabismus Questionnaire

• Acquired Brain Injury Questionnaire