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South East Ontario Vision Rehabilitation ServiceReferral Form
Please fax to
(1)6135428639Patient Information or Label
Name: ___Street Address: ___Health Card #: ______DOB: ___City: ___Phone: ___Postal
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How to fill out low vision rehabilitation services
How to fill out low vision rehabilitation services
01
Schedule an appointment with a low vision specialist
02
Complete a comprehensive eye exam to determine the extent of vision loss
03
Discuss goals and expectations with the low vision specialist
04
Receive individualized training on how to use low vision aids and devices
05
Learn techniques for optimizing remaining vision
06
Follow up appointments for monitoring progress and adjusting strategies as needed
Who needs low vision rehabilitation services?
01
Individuals with vision impairments that cannot be fully corrected with regular glasses, contact lenses, or surgery
02
People experiencing difficulties with daily activities such as reading, driving, or recognizing faces
03
Those looking to maintain or improve their independence and quality of life despite vision loss
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What is low vision rehabilitation services?
Low vision rehabilitation services are a range of integrated services aimed at helping individuals with visual impairments maximize their remaining vision and maintain independence.
Who is required to file low vision rehabilitation services?
Low vision rehabilitation services are typically filed by healthcare professionals, such as optometrists or ophthalmologists, who are working with individuals with visual impairments.
How to fill out low vision rehabilitation services?
To fill out low vision rehabilitation services, healthcare professionals must include the patient's medical history, current visual acuity, recommended treatments, and goals for improving visual function.
What is the purpose of low vision rehabilitation services?
The purpose of low vision rehabilitation services is to help individuals with visual impairments make the most of their remaining vision through specialized care, training, and assistive devices.
What information must be reported on low vision rehabilitation services?
Information that must be reported on low vision rehabilitation services includes the patient's name, date of birth, medical history, current visual acuity, recommended treatments, and goals for visual improvement.
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