Triage and Self Assessment

Q: Why/When would I fill out the Self Assessment or Triage Forms?

A: If you have a patient that continues to have limitations with functional performance or cannot meet the realistic goals you have set for them in a conservative, timely manner

Q: When do I fill out the Triage Forms versus the Self Assessment Form?

A: If you are a clinician/healthcare provider and feel that a patient of yours may benefit from our services, and you have additional information and professional input or insight that the patient may not recognize.
—If you are a clinician (PT/PTA, OTR/L / COTA, ATC etc.) that is Postural Restoration Certified or Postural Restoration Trained with a patient who cannot achieve/maintain neutrality, you should consider completing the triage forms.
— If you are a clinician/healthcare provider that has had minimal to no experience or knowledge with any of the PRI Vision and/or Postural Restoration Institute (PRI) courses, but feel you have a patient that may benefit from our services, you should have your patient complete the Self Assessment Form.
—If you feel you would personally benefit from our services based on any information/research you have gained about PRI Vision from other professional services, you should consider completing the Self Assessment Form.

Q: Why would the professional input from the Triage/Self Assessment Forms be beneficial?

A: It helps PRI Vision to determine whether a patient is a candidate for the services provided at PRI Vision, what level of services will be required and if additional input will be required prior to the appointment.

Q: When would I have my patient fill out the Self Assessment Form?

A: If you do not have the ability to complete the Triage Forms due to lack of knowledge in the tests/terms used referring to the Postural Restoration science/approach and/or due to time constraints.


1. Referring clinician needs to fill out BOTH forms (PRI Information and Optometric Information).

2.  Referring clinician needs to send the patients LAST 3 FULL VISION EXAMS. The patient’s information will not be reviewed until theses have been received.

3.Fax completed forms to us at 402.858.1037.

4. Ron and Dr. Heidi Wise will review the information. They will determine if the patient is appropriate for PRI Vision and the amount of time needed to evaluate the patient.

5.  If you circled “Y” to the question “Clinician Permission to Contact Patient Directly?”, we will contact the patient to schedule the evaluation once Ron and Dr. Heidi Wise have reviewed and approved the patient to be seen by PRI Vision. If you circled “N”, we will contact the referring clinician prior to the patient being contacted.


When you are referring a patient to PRI Vision for an initial evaluation, please make sure your patient has not made any other appointments for an initial evaluation with any other integrative disciplines on the same day. It is recommended that the patient be seen at PRI Vision FIRST, and then follow the recommendations per the PRI Vision Staff for any other disciplines that are needed. The PRI Vision Staff will advise as to which order any other disciplines should be scheduled. If the patient is coming to PRI Vision for a follow-up appointment, then the patient may need to see other integrative disciplines BEFORE the appointment with Dr. Wise and a PRI Vision Physical Therapist. Thank you for your cooperation in this regard, we appreciate it.