Dear Parents:

Hawaii Optometric Association with the support of the Rotary Club of (Club Name)will be performing vision screening on (Day),(Date) for grade3 at (Name of) School.

The screening will take approximately 7 minutes per student. The purpose of this screening is to identify children with nearsighted, farsighted and binocular problems (using both eyes together as a team). A written report will be given to all students who attend the screening detailing our findings. We also wish to share the results with the school health aide and the student’s teachers.

Vision screening is not a substitute for a comprehensive eye examination by an optometrist. It is recommended that scheduled eye exams for children be at birth, 6 months, 3 years old and before starting school. If your child missed these exams, the Hawaii Optometric Association and the American Optometric Association recommends you call a doctor of optometry and schedule an eye exam for your child.

For more information, please call Hawaii Optometric Association at 537-5678

If you do not want to have your child participate in the vision screening, please complete

the bottom portion and have your child return it to the teacher by _(Date Day before Screening)_.

(date

-----cut here------

I do not want my child, ______to participate in the vision screening on ___(Screening Date)______.

(date)

______

Signature of parent or legal guardianDate

Letter to parents, PASSED screening (to be folded, stapled and given to student to take home)

Your child’s eyes were tested on ___(Screening Date)___and based on those tests, your child has passed the vision screening. Screened items were as follows:

  1. Distance vision (for seeing the chalkboard)
  2. Far-sighted screening (to test for far-sightedness, which can effect reading)
  3. Near vision (for reading and writing)
  4. Binocular Vision (to make sure both eyes are working together)

These tests are only a small part of a comprehensive eye examination. Other conditions may exist which can be detected by a comprehensive exam. A yearly comprehensive examination is recommended to ensure that your child can visually perform to their potential.

For more information in locating a doctor of optometry, please call the Hawaii Optometric Association at 537-5678

Letter to parents, FAILED screening (to be folded, stapled and given to student to take home)

______had a vision screening on ___(Screening Date)___. He/she failed the following test(s).

  1. Distance vision (for seeing the chalkboard)
  2. Far-sighted screening (to test for far-sightedness, which can effect reading)
  3. Near vision (for reading and writing)
  4. Binocular Vision (to make sure both eyes are working together)

It is recommended that you contact a doctor of optometry and make an appointment for a comprehensive examination. Please bring this letter to the doctor so he/she may be able to perform further tests.

For more information in locating a doctor of optometry, please call the Hawaii Optometric Association at 537-5678