Forms and Surveys

A cartoon of Eyecare Kids' main mascot Max the Magician, holding a paintbrush

We would like to streamline your visit and enhance our services by gathering valuable insights about your eyes. Your answers will assist us in guiding you toward proactive measures for clear and healthy vision. By completing relevant forms and surveys, you are helping us improve your experience at Eyecare Kids.

Patient Form for Adults

Complete our patient form to ensure your visit is seamless. Providing accurate information helps us tailor our services to your needs, ensuring you receive the best care possible.

Patient Form for Child

Complete our patient form to ensure your visit is seamless. Providing accurate information helps us tailor our services to your needs, ensuring you receive the best care possible.

Brain Injury Vision Symptom Survey

This survey collects crucial details about your child’s head injury, aiding our understanding of potential vision-related symptoms and enabling us to offer the right care. Thank you for your important participation.

DVIP questionnaire

The DVIP questionnaire evaluates your child’s developmental vision information processing. Your responses offer valuable insights into their vision-related development, guiding us toward the next steps in their vision care journey. Thank you for participating.

Myopia Risk Survey

Curious about your child’s risk of myopia? Take our quick and informative myopia risk survey to gain insights into your child’s eye health and potential risk factors.

Classroom Vision Checklist

This checklist is designed to help parents, guardians and educators identify potential vision issues in children that may affect their learning. Since most kids do not complain of a vision problem, your observations and responses will contribute to a more supportive and effective learning environment for your child.

Convergence Insufficiency Symptom Survey (CISS)

Convergence Insufficiency is an eye condition that affects how your eyes work when focusing on nearby objects. This can result in eye strain, double vision and or reading difficulties. Your completed CISS will be reviewed by our optometrists who will be able to make preliminary risk assessments of CI in your child.

Ocular Surface Disease Index Survey

This survey is designed to assess and quantify the symptoms of ocular surface diseases, such as dry eye syndrome, in adults. Your participation will provide valuable insights into your eye health and help in the evaluation of your ocular surface condition. Thank you for taking the time to complete this survey.

Book a comprehensive eye test for your child today.

Danny the dragon

Book a comprehensive eye test for your child today.

Danny the dragon