2014 July School Vision Evaluation Tracking

1. July School Vision Evaluation Tracking

The Nebraska Foundation for Children's Vision and the Nebraska Optometric Association are partnering to collect data that will support the need for enhancing Nebraska’s current law requiring vision evaluations for students before entering kindergarten in order to assure better quality exams and better compliance.

We need your help to collect this data. Please enter your data below for the school vision exams you have conducted in July. If you have more than one office, please do separate surveys for each location.

This survey is for the month of July only.

Please go to www.nechildrensvision.org/SchoolVisionEvaluationTracking.html to enter data for other months.

Question Title

This data is for the

main practice office

satellite office

Other (please specify)

Question Title

Please fill out these questions.

OD Name(s):

Practice Name:

Practice Location:

Your Name (person entering information):

Your Title: