Assessment Form

Assessment Form

Assessment Form

Assessment Form

Assessment Form

Take The Assessment

Assessment Form

Parent's Name

Child's Name

Email

Phone Number

How old is the child?

Is the child already nearsighted or myopic? (wears correction to see better in the distance)

Are the child's parents myopic?

How many hours does the child spend outdoors? (including breaks or recess at school)

*A team member will reach out to you regarding your results. Please give us at least 2 business days.

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