Eye Test and Prescription Record

Who this is for

One sheet for your eyes. The top table logs each test with the date, the practice and what you were told; the middle one is blank space to copy your own prescription figures exactly as they are written on it; the last records the glasses, lenses and frames you have bought and what they cost.

Anyone whose prescription has changed more than once, people buying glasses or lenses somewhere other than where they were tested, parents keeping a child's record, and anybody who has hunted through a drawer for the last prescription slip.

What this helps you track

• Every test in date order with the practice and the optometrist
• What you were told at the test, in the words you were given
• Your prescription figures copied straight from your own prescription
• The next test date you were given, if you were given one
• Frames, lenses and contact lenses bought, with supplier and cost

How to use it

1. Fill in your details and your usual practice at the top of the sheet.
2. Log each test as it happens: date, practice, who tested you and what you were told, written the way it was said.
3. Copy your prescription figures into the middle table exactly as they appear on your own prescription — one line per eye, per prescription date.
4. Leave blank any column your prescription does not use, and put anything it shows that the columns do not into the last column.
5. Record frames, lenses and contact lenses in the bottom table with the supplier, the cost and the date collected.
6. Take the sheet with you when you buy glasses elsewhere, or fill it in online and save it in your own browser.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Are there any example figures on the sheet?

None at all. The prescription columns are empty and stay empty until you copy your own figures in. Nothing on the page is a suggested, typical or expected value for anybody's eyes.

Does it tell me what my prescription means?

No. It records the figures and nothing else. What they mean, whether they have changed and what to do about it is a conversation with the optometrist who wrote them.

My prescription has headings these columns do not.

Practices and countries lay prescriptions out differently. Copy what you can into the columns that match, and put everything else into the last column word for word rather than trying to convert it.

How often should I have my eyes tested?

The sheet does not say and carries no interval. The next date column is for a date you were actually given; if you were not given one, leave it empty.

Why record what I paid for glasses?

Because people often buy frames and lenses separately, at different places and months apart, and the receipts scatter. A dated line with the supplier on it makes a warranty or repair question much easier.