Download Visual Field Test

Visual Field Test
For Early Detections of
Visual Disorders
The Humphrey FDT Visual Field Test measures the retinal function and sensitivity to light. No
eye drops, no discomfort!
As you look into the computerized instrument you’ll be asked to press a button each time you
see the target. Results are immediately available for our Doctor’s review.
Visual Field Testing can assist in important early detections of many disorders such as:
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Glaucoma
Diabetic Retinopathy
Retinal Detachment
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Brain Tumors
And many more…
Our Doctors strongly recommend this quick, yet accurate exam for all patients, especially those
who have any of the following:
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Headaches
Flashes of light or floaters
Family history of diabetes
History of high blood pressure
Heart problems
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Taking medications
Strong eyeglass
prescription
Reduced vision without an
apparent reason
There is an additional charge of $30.00 for this screening exam and is recommended to be
tested annually, sooner if deemed necessary by the doctor. You’ll be given a receipt, as your
Insurance Plan may reimburse you for this medical procedure. Visual Eyes does not guarantee
reimbursement. Check with your insurance company regarding coverage.
I have read and understand the information regarding the Humphrey FDT Visual Field Test
______Yes, I do want the Visual Field Exam.
Exam.
______ No, I do not want the Visual Field
Patient’s Signature: ________________________________________________
Date:________________