Low Vision Collaboration Clinic+ Forms

A Low Vision Collaboration Clinic+ (LVCC+) is for infants, toddlers or school-aged children who have alternative communication and complex needs.

Information needed for Low Vision Collaboration Clinic+ are:

1. Please complete the following KanLovKids LVCC Forms.

• • Parents Complete the following forms:
    • Consent Form for Onsite Clinics OR Consent Form for Virtual Consultation
    • Photograph and Media Release Form
    • Child Family History Form

• • TSVI/COMS Complete the following forms:
    • Contact Information Form for LVCC and LVCC+
    • Student’s Eye Doctor Information Form

• • If you prefer, please print all KanLovKids LVCC+ Forms, fill them out, and email them to Molly Reardoncreate new email

• • • Consent Form for Onsite Clinicsopens PDF file or Consent From for Virtual Consultationopens PDF file
    • Contact Information Form, Student’s Eye Doctor Form, Child/Family History Form, and Photograph and Media Release Formopens PDF file

1. Release form from Dr. Linda Lawrence’s officeopens PDF file (only needed for Dr. Lawrence’s clinics) Do not write KanLovKids on it.

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

BRING SUPPORTED SEATING EQUIPMENT AND TRAVEL OR WHEELCHAIR TRAYS, ALONG WITH TOYS OR OBJECTS THE CHILD PREFERS.