Disclaimer:

This form and consultation in no way replaces a full Eye Exam which is needed to evaluate vision and total ocular health on a yearly or bi-yearly basis.  This vision questionnaire helps us determine general information about your vision and health risks.  If you are provided with a prescription, we still strongly recommend you have a full exam and will provide you with help doing so.

All data you submit, as a Patient or Guardian, will be treated in accordance with the Indiana Eye Doctors HIPAA agreement found here [https://www.indianaeyedocs.com/pubfiles/Indiana%20Eye%20Doctors%20Privacy%20notices.pdf]. Any information received will be securely stored, and the data not shared with any party outside of the Indiana Eye Doctors organization without the express consent of the Patient or Guardian.