Alderwood Vision Therapy

After instruction from our staff, please print and complete the appropriate forms, and bring them with you to your appointment.

New Patient Exam Forms

• Child Exam
• Adult Exam

If eye turn present:

• Child with Eye Turn
• Adult with Eye Turn

New Patient Consultation Forms

• Child Consult
• Adult Consult
• Vision Rehabilitation (acquired brain injury, stroke, motor vehicle accident)

If eye turn present:

• Child Consult with Eye Turn
• Adult Consult with Eye Turn

Returning Patient Forms

• Child Returning Patient
• Adult Returning Patient

Other Forms

• Consultation Referral Form for Optometrists
• Quality of Life Symptom Checklist for Progress Evaluations
• HIPPA – Notice of Privacy Practices Form
• Release of Records