Vision Screening Forms, Tools and Resources
Training Manual
Child and Teen Checkups
- C&TC Vision Screening Materials
- Child and Teen Checkups Schedule of Age-Related Screening Standards (PDF)
- Vision Screening Fact Sheet (PDF) Revised 04/2021
Forms
The following forms are available as printable PDFs
- Child and Family Vision History and Risk Assessment Questionnaire (PDF) Revised
- Color Vision Advisory Letter (PDF)
- Diseases and Conditions Associated Vision and Eye Abnormalities (PDF)
- Teacher and Child Vision Pre-Screening Worksheet (PDF)
- Vision Screening Worksheet (PDF)
- Vision Referral Letter (PDF)
Assessment Tools
Clinic Settings
- Child and Family Vision History and Risk Assessment (PDF)
- Distance Visual Acuity HOTV/LEA Symbols Vision Charts (PDF)
- Distance Visual Acuity Sloan Letters Vision Chart (PDF)
- Plus Lens (PDF)
- Visual External Inspection of Eye (PDF)
Community Settings
- Child and Family Vision History and Risk Assessment (PDF)
- Corneal Light Reflex (PDF)
- Distance Visual Acuity HOTV/Lea Symbols Vision Charts (PDF)
- Distance Visual Acuity Sloan Letters Vision Chart (PDF)
- Plus Lens (PDF)
- Unilateral Cover Test (PDF)
- Visual External Inspection of Eye (PDF)
Materials
- LEA Symbols Prescreening Practice Sheet (PDF) Reviewed 01/2022
- HOTV Prescreening Practice Sheet (PDF) Reviewed 01/2022
- Equipment for Visual Acuity Screening (PDF) Reviewed 04/2022
Online Vision Resources
- American Academy of Ophthalmology
- Minnesota Academy of Ophthalmology
- American Association for Pediatric Ophthalmology & Strabismus
- American Optometric Association
- American Academy of Pediatrics
- American Academy of Family Physicians
- MDE Early Childhood Screening
- National Center for Children's Vision and Eye Health
- National Eye Institute
- Sight & Hearing Association
Last Updated: 06/24/2024