Visual ABI Questionnaire-Geelong Logo
  • Visual ABI Questionnaire-Geelong

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  • Regarding the injury:

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  • Lifestyle:

  • Thinking about daily activities including shopping / cooking / cleaning/ personal hygiene / socialising / exercise

  • What percentage of daily activities would you estimate you can currently do compared to prior to injury? %.

  • Please note that by completing this form you consent to participating in a neuro visual examination. Your eye examination may include and is not limited to: Visual Acuity, possible spectacle prescription, a binocular vision assessment, use of equipment for scans and other assessments, and ocular health. These results will be documented in our medical records and in your report (if appropriate). The imaging from scans and glasses prescriptions are not included but may be requested. At Kiddies Eye Care our priority is your eye health. Please notify the Optometrist if you do not wish to participate in a specified test. 

    Additionally we are a private billing practice and payment is required at time of consultation. If you are funded by TAC or WorkSafe we will provide an invoice that  will assist you to get reimbursed. Please call 5202 5911 for further clarification of fees. 

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