Low Vision Collaboration Clinic Forms

Please complete the following KanLovKids LVCC Forms.

• Parents Complete the following forms:
  • Read the Letter to Parents/Guardians about the Low Vision Clinics
  • Permission and Record Release Form

• TSVI/COMS Complete the following form:
  • TSVI/COMS Form

You may also print all of the forms to completed on paper and then scan and send them to Molly Reardon.

Fill this out only if KSSB Field Services Specialists requests it for the doctor Impact of Vision Impairment for Children (IVI-C for 12 to 18 years of age). This form should be completed online, as it will be automatically scored.

ALL DOCUMENTS ARE  DUE TWO WEEKS BEFORE CLINIC DATE  (be sure to indicate if ASL or Spanish interpreter is needed).

BRING SAMPLES OF STUDENT’S WORKSHEETS, TEXTBOOKS, ETC.