When you first visit Eyes on Oxford it is important for the optometrist to know as much as possible about the eye and vision issues that bring you to see us, and many other factors which can influence your vision, as well as the possibilities for caring for your visual needs.

For adults, this can include your visual symptoms such as blur, headaches and eyestrain; how you use your vision for reading, computers and distance tasks; your general health and medications; your history of vision and eyecare in the past; and your family eye history.

For children, we need to know their vision problems and any current or past treatment, such as previous glasses, exercises, surgery or patching; their progress in learning to read or write; their developmental progress; and their health and family history.

To make it easy to gather this information, could you please print the form which applies to the person(s) coming for an exam at Eyes on Oxford, fill it out and bring it with you on the day of the appointment. For children there is a form for the parents and a form for the child to fill out (to help them to feel less apprehensive if necessary; for young children you may need to help them a bit!)

Adult welcome to the office form

School child welcome form

Preschool child form (coming soon)

Child patient’s own form

Acquired brain injury form (coming soon)

Referral for Neuro-Optometric Assessment

Teacher’s referral form