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Vision Therapy Initial Assessment Form

Asks about primary vision concern, reading difficulties, and double vision. Built for behavioral optometry practices.

Questions
10
Page
1
Time
about 3 min
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Vision Therapy Initial Assessment Form

Live preview. Tap through it like a patient.

Who it is for

  • Behavioral Optometry Practices
  • Pediatric Eye Care Centers
  • Occupational Therapy Clinics
  • Neuro-Optometry Specialists
  • School Vision Programs

Formisoft for Mental HealthFormisoft for OptometryFormisoft for Pediatrics

What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

  1. Patient NameText · Required
  2. Date of BirthDate
  3. Primary Vision ConcernLong Text
  4. Reading DifficultiesLong Text
  5. Double Vision?Multiple Choice · 3 choices
  6. Headaches with Near Work?Multiple Choice · 3 choices
  7. Eye Strain SymptomsLong Text
  8. Academic Performance ImpactLong Text
  9. Previous Eye ExamsLong Text
  10. Assessor NameText

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Vision Therapy Initial Assessment Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 10 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Vision Therapy Initial Assessment Form works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Vision Therapy Initial Assessment Form to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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