Children's Vision Form

The IOA Public Health Committee developed the children's vision form as an efficient way to communicate examination findings to pediatricians and pediatric nurse practitioners. The form contains treatment options and plans that are more relevant to modern pediatric optometry practice. To make it user-friendly, we have both a printable option and a fillable PDF available below. We want to encourage all IOA members who see pediatric patients to consider sending this form, even with normal examination findings. This lets local providers know that a member not only sees pediatric patients but will also share information about ongoing care and treatment plans.

Children's Vision Form - Fillable Version

Children's Vision Form - Print Version

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