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Vision Screening Follow Up

The form below is to request more information related to the recent children’s vision screening. Once submitted, the form will go to the PAB Member Agency which serves the county in which the screening site is located. Please allow a few days for someone to contact you.

Vision Screening Follow-Up Request

The full name of the person to be contacted.
The name of the child who received the vision screening.

Screening Site Information

Where did the vision screening take place?
When did the screening take place? (If you don't know the exact date, it is ok to say something like "last Tuesday".)
Please choose the county where the screening took place. Selecting the correct county will enable quicker response from the appropriate agency.