Your child's first name
Ethnic background East Asian South Asian European African Hispanic Middle Eastern Indigenous Australian Mixed / Other Short-sightedness runs differently in different families and backgrounds — this helps your clinician read the picture.
How many of the child's parents are short-sighted? Neither parent One parent Both parents “Short-sighted” means needing glasses or contacts to see things far away clearly. A best guess is fine.
Does a brother or sister wear glasses for short-sightedness? No / not sure Yes
Is the child already on any myopia treatment? (optional) Not sure / none — my clinician will confirm DIMS spectacles HAL spectacles (gen 2) Orthokeratology Atropine 0.05% Atropine 0.025% Atropine 0.01% Red-light therapy Combination You can skip this — if you're not sure, your clinician will confirm it.
This just gives your eye-care professional a head start — it is not a diagnosis, and they always have the final say on your child's care.