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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: When emailing documents, please put clinic date in the subject box.
  1. Consent Letter
  2. Contact Information Form (Use Child/Student’s Legal Name);
  3. Child-Student Eye Doctor's Information
  4. Child Family History Form
  5. Release form from Dr. Linda Lawrence's office (only needed for Dr. Lawrence's clinics) Do not write KanLovKids on it
  6. Provide the most recent Eye Report, Functional Vision/ Learning Media Assessment, Clinic Low Vision Evaluation, Medical Records and Orientation and Mobility Report
  7. Media Consent Form
  8. Parent / Guardian Low Vision Collaboration Clinic+ Letter (please fill this out BEFORE sending home to parents--parents keep this)
Please email documents (1-7) listed to Erin Kelly  ekelly@kssdb.org   913-305-3061     
ALL DOCUMENTS ARE  DUE ONE MONTH 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.

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