Optometry Incident Report Form

 

This incident report form collects information to support advocacy initiatives that confirm the value of comprehensive eye health examinations and optometric services.

Please complete an incident report form for patients who have:
• asymptomatic eye disease
• had a sight test (independent automated refraction) and experienced a problem
• problems with contact lenses or eye glasses purchased online OR without a prescription.

Your cooperation in the collection of this information is essential to help your association provide evidence to influence government health policy decisions that support the position that regular eye health exams are important for early diagnosis and beneficial to reducing health care costs.