952-844-0844 mvtc@minnesotavisiontherapy.com
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Minnesota Vision Therapy Center
  • Vision Therapy
    • What is Vision Therapy
    • Functional Vision
    • Diagnoses
      • Convergence Insufficiency
      • Strabismus
      • Amblyopia
      • Dyslexia
      • ADHD / ADD
      • Concussion & Acquired Brain Injury
    • Vision & Learning
      • Visual Learning
      • Reading
      • Math
      • Spelling
      • Handwriting
      • Receptive and Expressive Language
    • Primitive Reflexes
    • Vision Therapy Programs
    • Program Length
    • Costs & Insurance
  • Programs
    • Vision Therapy
    • Program Length
  • Symptom Checklist
  • Evaluation
    • Evaluations
    • Symptom Checklist
  • Resources
    • Testimonials
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    • Vision Therapy Research
    • Professionals
Select Page

Registration Forms

Print the appropriate paperwork for your Evaluation.  Bring completed forms with you to the appointment.

Student

Student History Form

Symptom Checklist

Release Form

 

Adult

Adult History Form

Symptom Checklist

Release Form

 

For concussion or brain injury evaluations, complete the Concussion-Brain Injury Symptom Checklist instead of the standard Symptom Checklist.  Complete all other forms for your age group.

 

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