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Below are tools that you can download and reproduce to assist you with documentation and follow-up of the children that you have screened.

In addition to having the appropriate tools for documentation, you need to have a consistent system in place (for the whole school or the whole office) for ensuring that necessary information gets recorded. Make sure that all people involved understand the system, make sure that all involved know what type of information to give parents/caregivers when a child is referred and have a system in place for follow up when documentation is not received from the parent or eye care professional after a referral


Documentation and follow-up is a critical component of vision screening!

Childcare Brochures

The child care brochure should be used when you are conducting a vision screening in a child care or Head Start environment.

Recording Form

The recording form can be used either in a child care/Head start environment or in a health care setting. This tool will help you track addresses and phone numbers for follow up, critical information about screening results and will help you to ensure that your referral rate stays within an acceptable range.

Primary Care Brochures

The primary care brochure should be used when you are conducting a vision screening in a health care setting such as a pediatrician's office.

Vision History Form

The Vision History Form has been developed for use in the pediatric office environment. It is based on the AAP Policy Statement for Eye Examination for Infants, Children and Young Adults by Pediatricians.


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