Record Forms for iSeries Pediatric Model 1 Pad/50 Sheets

Titmus Vision Screening Record Forms

Easily document vision screening results with our user-friendly record forms, designed to streamline post-screening data entry and ensure consistency.

Quick Guide to Using the Form:

• Top Section: Enter relevant information about the individual being screened.
• Pass/Fail Tests: Check the appropriate column to indicate results.
• Acuity Tests: Mark the correct level by checking, circling, or writing in the box (e.g., “20/20”).
• Additional Tests: Includes depth perception, color vision, muscle balance, and more.
  • Indicate final responses by drawing a diagonal line through or circling the appropriate result.

These forms help maintain accurate records and support follow-up care when needed.

End-of-Life Notice: The Titmus iSeries was officially retired in 2006 and has since been succeeded by the V Series.