At Vision Development Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.
- You will need AdobeReader® to download and complete the forms. Click here to download.
- Download the required form(s). Print out the form(s) and complete the required information.
- Email or fax your printed and completed form(s) to our office. Our fax number is (812) 482-1422 and our email address is visiondevelopmentcenterjasper@gmail.com.
Adult
Vision Checklist for Adults (PDF)
Adult General Questionnaire (PDF)
Adult Strabismus(Eye turn) Questionnaire (PDF)
Traumatic Brain Injury/Stroke Questionnaire (PDF)
School Aged Children
Vision Checklist for School Aged Children (PDF)
Child General Questionnaire (PDF)
Child Strabismus(Eye turn) Questionnaire (PDF)
Infant/Toddler/Preschool
Vision Checklist for Preschool (PDF)
Preschool Questionnaire (PDF)
Infant/Toddler Questionnaire (PDF)
Strabismus Addendum (PDF)
Sports
Sports Vision History Form (PDF)
Sports Vision Changes Checklist (PDF)
Additional Forms
Performance Changes Checklist (PDF)
Vision Therapy Reimbursement Packet (PDF)