An eye examination is a process by which an optometrist or ophthalmologist determines the health of your eyes and prescribes eyeglasses or contact lenses, if necessary. During an eye examination, your optometrist will ask about any vision problems you're having and test how well you see both at distance and up close. He may also measure the curvature of your cornea and test the pressure inside your eyes. Depending on what he finds during the exam, your optometrist may also prescribe medication to help protect your eyes from disease. An eye examination is a vital part of maintaining overall eye health. If you're experiencing any vision problems, be sure to make an appointment with an optometrist as soon as possible.
You can find information about the type of form you want to complete in the table. It will tell you the span of time you will need to finish eye examination, what fields you will have to fill in, and so on.
| Question | Answer |
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| Form Name | Eye Examination |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | eye exam sheet template, optometry exam form, ophthalmology exam forms, optometry exam form pdf |
PM 529 |
Department of Defence |
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Revised Mar 2005 |
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Eye Examination |
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PFID number (Recruiting use only) |
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Use only black pen and/or stamps |
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Health facility or Defence Force Recruiting Centre |
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Employee ID |
Rank |
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Service |
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Family name |
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Unit, ship or section |
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Given name(s) |
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Corps, category or mustering |
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Date of birth |
Gender |
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Visual acuity |
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Encl/Folio
Distance vision |
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Right |
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Left |
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Corrected |
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Uncorrected |
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Near vision (Corrected) (Special Forces applicants only) |
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Right |
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Left |
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N5 at |
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N14 at 100cm |
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Refractive limits with effective cycloplegia (Cyclopentolate HCL 1% is to be used) |
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Right |
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Left |
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Hypermetropia |
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Hypermetropic astigmatism |
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Myopia |
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Myopic astigmatism |
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Heterophoria |
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Right |
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Left |
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Exophoria |
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Esophoria |
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Hyperphoria |
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Hypophoria |
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General physical examination |
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Normal or abnormal |
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Comments |
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Fields of vision |
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Diseases of the eyelid |
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Fundus examination |
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External and anterior segment |
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Right |
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Left |
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Intraocular pressure (mmHg) |
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History of refractive surgery |
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Second appointment (Required if contact lenses worn) |
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Right |
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Left |
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Visual acuity wearing lenses |
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Spectacle blur |
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Comments |
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Recommended MVR |
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MVR 1 |
MVR 2 |
MVR 3 |
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Signature |
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Printed name |
Ophthalmologist or optometrist |
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Date |
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PM 529 - Page 1 of 1