Early Childhood Vision Screening

Start here if you are interested in sponsoring a “Early Childhood Vision Screening” in your community. The top three files are available for you to open and print. Click on the document name. These three documents are in PDF format. If you don’t have Adobe PDF Reader, you can download the Adobe program for free at www.adobe.com.

Sponsor Application Form
This file is where you start! Fill out this form, enclose a check, and return it with a couple of potential dates for the screening that you service club would like to hold.

Proper Procedures for Conducting a Successful ECVS Project
Please read this file before you fill out the location survey form.

Timeline Schedule
This file is designed to help a service club know when to be working on each step in preparing for and holding an “Early Childhood Vision Screening” event.

The rest of these files on this list will be made available to your service club if your service club chooses to schedule an early childhood vision screening in your area. You will be mailed the following files. Many of them are in MicroSoft doc format, so you can modify them to meet your needs.

ECVS Packet Cover Sheet

Understanding the Screening Results
This 36 page document is a file that is designed to be given or emailed to Ophthalmologists and Optometrists that already specialize in working with children who are less than one years old through four years old. It is an explanation of how to use the referral printout that parents bring to them after a “Early Childhood Vision Screening” performed by a ROATx Certified Vision Screener. 

Examples of Locations to Take the Fliers
This file is a copy of a list of childcare centers and churches. It is included to give the service club sponsors an idea of where to start handing out fliers and encouraging local childcare providers about the vision screening that is about to be held.

Sample of Handout at Screening
This handout file is a sample of what should be given to all the families that bring their children to a screening. It talks about the Pediavision equipment, the highly trained Certified Vision Screeners, and on the back page is room to tell about the sponsoring service club that has organized the screening.

Sample of Permission Slip
This permission slip file is designed to be modified by your service club so that it reflects your clubs information. It also assures your club that it has permission to screen a parents child.

Screening for Amblyopia paper

Two-sided Sample Flyer (BACK)
This file is the back page of the two sided flier that is used to promote the screening. It is a PDF document that can not be changed.

Two-sided Sample Flyer (FRONT)
This file is the front page of the flier. It is designed to easily be modified to a service clubs information. It is a DOC file.

Two-sided Sample Flyer (FRONT-MASONIC SAMPLE)
This file shows the front of the flier completed, to give you a sample of how it should look. It is a DOC file.

Who Provides Ophthalmic Services and Products
This file explains the differences between the “Three O’s”.