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COASTALCAROLINACOMMUNITYCOLLEGE 444WESTERNBOULEVARD JACKSONVILLE,NC285466877EYEEXAMINATIONFORMPatientsName: LastFirstM. I. Address: Street/P.O. BoxCityHomePhone:() StateZipCodeDateofBirth: / / VISUALACUITY:SLIT

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How to fill out eye exam form

01

Begin by providing your personal information such as name, date of birth, and contact details.

02

Fill in any medical history related to your eyes, such as previous eye surgeries, current medications, or any known conditions.

03

Move on to answer questions about your vision, such as whether you wear glasses or contact lenses, any difficulties seeing at certain distances, or any color blindness.

04

If applicable, provide information about your current eye prescription or bring your glasses/contact lenses for the doctor to review.

05

Answer any additional questions or concerns provided by the form, such as family history of eye diseases or any recent eye-related symptoms you may have been experiencing.

06

Finally, review the form for accuracy and completeness before submitting it to the eye care professional.

Who needs eye exam form?

01

Anyone who needs to undergo an eye examination or visit an eye care professional would typically need to fill out an eye exam form. This includes individuals who are experiencing vision problems, seeking new glasses/contact lenses, or undergoing routine eye check-ups.

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What is eye exam form?

Eye exam form is a document used to record the results of an individual's eye examination.

Who is required to file eye exam form?

Individuals who are required to undergo an eye examination, such as drivers or pilots, are required to file the eye exam form.

How to fill out eye exam form?

Eye exam forms can be filled out by the individual undergoing the examination or by a qualified eye care professional.

What is the purpose of eye exam form?

The purpose of the eye exam form is to document the results of the eye examination and ensure that the individual meets the required vision standards.

What information must be reported on eye exam form?

The eye exam form must include the individual's name, date of birth, examination date, results of the examination, and the signature of the eye care professional.

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