optometry@cooroy

These questionnaires are designed to be filled out by the parents of pre-teen children & the teachers of primary school age children who attend our practice for consultation.

By printing & filling out these forms before your child's examination you will have time to consider your answers & check relevant details. This will allow us to spend even more time with you and your child during your consultation. The questionnaires are in pdf format.

• PARENTS Pre-Examination Questionnaire

For use regarding pre-teen children.

Please print, complete & bring this form
with you to your child's visual examination.

• TEACHERS Pre-Examination Questionnaire

For use regarding primary school age children
(or older children where a specific teacher has recommended a visual assessment).

Please print this form and pass on to the teacher
& then bring with you to your child's visual examination.

All forms may also be faxed or scanned & emailed to our office prior to the consultation.