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Student Name: Age: School: District: Benton County A. Hearing Screening B. Vision Screening Instrument I-,-- ????.'/, ?.?., :? 2nd Screening PASS FAIL EXAMINER DATE 1st Screening 2nd Screening Screened
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Start by downloading the hearing and vision form pdf from the appropriate website or source.
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Open the downloaded pdf file using a pdf reader software or application on your device.
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Carefully read the instructions provided on the form pdf to understand the information it requires.
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Begin by filling out the personal details section, which may include your name, date of birth, address, and contact information.
05
Next, proceed to the hearing section and accurately report any hearing-related information such as hearing aids or devices used, if applicable.
06
In the vision section, provide details about your visual acuity, any corrective measures used (such as glasses or contact lenses), and any vision problems or conditions you may have.
07
If required, complete additional sections of the form that pertain to specific medical history, previous surgeries, or any other relevant information.
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Double-check all the information you have provided to ensure accuracy and completeness.
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If necessary, consult with a healthcare professional or eye and ear specialist to gather any required medical records or additional information.
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Who needs the hearing and vision form pdf?
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Individuals who are undergoing a medical examination or assessment to determine their hearing and vision capabilities may need to fill out the hearing and vision form pdf.
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Educational institutions, such as schools or colleges, may require students to fill out the hearing and vision form pdf to ensure appropriate support or accommodations are provided.
Overall, anyone who is seeking to provide accurate information about their hearing and vision status for medical, occupational, or educational purposes may need to fill out the hearing and vision form pdf.
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