eye care sign

Our Services

Pre-exam questionnaires

Meet our optometrist

Meet our vision therapists

What is Vision Therapy?

Visually related learning difficulties

"Lazy" eyes

Binocular coordination therapy

Sports vision therapy

Success Stories

Vision therapy references

How to refer to Calgary Vision Therapy

Location and hours

Evaluation Fees

Preschool age

School Age


Sports Vision


Pre-Exam Questionnaires

The following questionnaires are required to be printed out, filled in carefully and completely, and brought to our office for your first scheduled visit. Answers to the questions within these forms contains diagnostic information that Dr. Neufeld requires to better understand your/your child's visual difficulty.

(All forms are in ADOBE PDF format. If you need the free reader from Adobe, go to DOWNLOAD)

A) Forms for Learning difficulties (VRLD = visually related learning difficulties), Reading difficulties, Reversals, Achieving below potential at school, Attention difficulties (ADD/ADHD):

B) Forms for referrals for Strabismus, Amblyopia, "Lazy Eye", Binocular coordination issues:

C) Forms for Sports Vision visual assessment (coming soon)


Map and driving directions: see Calgary Vision Therapy location on Google maps.

Call 403-242-1800 or email Calgary Vision Therapy with any questions you may have about these forms.

Email: Dr. Brent Neufeld, Optometrist with any questions you may have