This service evaluation study of a hospital single centre stroke service was undertaken to determine reasons for declining sight registration, whether patients feel supported without registration and determine changes needed to improve registration processes. A review of existent data was coupled with telephone interview information. Of 494 stroke survivors, 54 were eligible for sight impairment registration. Thirty-one were not offered registration; nine were in care homes, eight on palliative care, six had died, four were already under ophthalmic care, two had moved out of area and two had not attended clinic appointments. Of the remaining 23, 14 had proceeded with registration and nine had declined at their last appointment. Four of the nine were not contacted for this study; two had registration done by ophthalmology more recently for unrelated ocular conditions and two had declined any further orthoptic input. Five patients were interviewed by telephone as part of this service evaluation. At the time of the interview, all reported being able to access appropriate support services with their needs met without registration. All were re-offered registration; three declined and two accepted. The authors discuss factors potentially associated with under-registration of those eligible, including clinicians knowledge of the process, correct timing to offer registration and knowledge of the eligibility criteria, stigma, concerns regarding impact on insurance and difficulty attending appointments due to other disabilities. Length of time between discharge and contact with orthoptists may influence decisions to later proceed with registration. Limitations for this study are its small sample size. The authors recommend that a standard post-discharge telephone consult is incorporated in follow-up for those patients who decline registration as they may wish to proceed with this at a later date.