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)
 

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