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Ocutech® Inc. • Bioptics for Low & Impaired Vision • Call 919-967-6460
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Self Assessment Form

Dear Friend,
Ocutech frequently receives requests from individuals seeking advice about which Ocutech bioptic might be best for them. Certainly, the final decision should be based upon the recommendations of your low vision specialist after testing and evaluation of our devices. However the results of this questionnaire might help you begin to identify an appropriate Ocutech product as well as determine the likelihood of a favorable prognosis to benefitting from the device. Please understand that the report that you will receive from Ocutech is based upon the responses you provide and is NOT a prescription. Each questionnaire is reviewed by one of our trained and experienced staff. Please allow up to 5 working days to receive your response.
We hope this information will be helpful to you.
Model VES II copy