Forms and Clinic Information

To schedule a KanLovKids Clinic  Low Vision Collaboration Clinic (LVCC) or   Low Vision Collaboration Clinic + (LVCC+) 1.  Please contact your KSSB Regional Field Services Specialist  to schedule a clinic in your area and to discuss which type of Low Vision Clinic would be more appropriate.  The Field Service Specialist are:  Area Served Field Services Specialist   Phone Email   Southeast Region Julie Ituarte 913-945-0769 jituarte@kssdb.org  Northeast/KC Metro Region Molly Reardon 913-309-7041 mreardon@kssdb.org    Central/North Central   Region Anna Cyr 913-645-5324  acyr@kssdb.org  South Central Region Debbie Moody 913-982-7712  dmoody@kssdb.org  Western Region: Menely Hogan  913-645-2659 mhogan@kssdb.org 2.  Download and complete either the forms for the LVCC Evaluation or LVCC+ Evaluation. 3.  Please email all required documents to Erin Kelly  ekelly@kssdb.org   913-305-3061       ALL DOCUMENTS ARE  DUE ONE MONTH BEFORE CLINIC DATE   BRING SAMPLES OF STUDENT’S WORKSHEETS, TEXTBOOKS, ETC. What Happens Next? The Regional Field Services Specialist will contact the doctor’s office to setup a date and time for the evaluations and then send you a Clinic Schedule for you to complete and return. Erin Kelly will upload the completed documents to KSSB’s Google Drive so that the doctor will have on-line access to prepare for the evaluation. After the evaluation, a report will be generated by the doctor and distributed to the TSVI/ECI to deliver to the family and school. KSSB will send an invoice to your district after completion of the LVCC or LVCC+ for the children/students assessed.  The invoice will be sent to the designated person indicated by you on the Contact Information Form. Services for birth-three will not be billed (do not fill out billing contact info). If you have additional questions, please contact Judy Imber, KanLovKids Coordinator at (913) 645-5843 or jimber@kssdb.org. Other Forms Low Vision Clinic Collaboration Clinic+ (LVCC+) (pdf) Media Consent Form (pdf) Sign In Sheet (pdf) Vision Form for Driving (pdf)