Vision Therapy Training Session Log Form
Please complete this form to log details of each vision therapy training session. Accurate session records help track progress and plan future therapy.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Full Name
*
First Name
Last Name
Therapist Full Name
*
First Name
Last Name
Session Duration (minutes)
*
Exercises Performed
*
Saccadic Eye Movements
Pencil Push-ups
Brock String
Lens Flipper
Computer-based Training
Other
Patient Response / Progress
*
Significant Improvement
Moderate Improvement
No Change
Worsening
Other
Issues or Challenges Observed
Next Steps / Recommendations
Additional Comments
Submit Session Log
Should be Empty: