HOSPITAL or PROVIDER NAME/LOGO Hospital/provider address Department of Orthoptics – Vision Screening Service Contact detals: phone number 11 July 2017 (date in this format) Dear Parent/Carer of [child’s name] Vision screening for children aged 4 to 5 years We are inviting your child to receive vision screening. This will take place at name of school during the week commencing date in above format. We enclose an information leaflet to explain what vision screening is and what happens if your child is found to have reduced vision. You should take time to read this information. If you DO NOT want your child to have vision screening, please complete the slip below. Otherwise we will assume you are happy for your child to be screened. …………………………………………………………………………………………………………………… Vision screening at age 4 to 5 years Complete and return only if you DO NOT want your child to have vision screening. Name of child: …………………………………….……………..……… Date of birth: …..……………………… Address: ………………………………………………………………………..……………………………………………… Postcode: …………….………………………. I DO NOT want my child to have vision screening (tick box if appropriate) Signed (parent/carer) ……………………………………………………………………………………………….. Name in full (print clearly in capital letters) ………………………....…………………………………… Please return this reply slip to your child’s school by date in above format
HOSPITAL or PROVIDER NAME/LOGO Hospital/provider address Department of Orthoptics – Vision Screening Service Contact detals: phone number 11 July 2017 (date in this format) Dear Parent/Carer of [child’s name] Vision screening for children aged 4 to 5 years We are inviting your child to receive vision screening. This will take place at name of school during the week commencing date in above format. We enclose an information leaflet to explain what vision screening is and what happens if your child is found to have reduced vision. You should take time to read this information. If you DO NOT want your child to have vision screening, please complete the slip below. Otherwise we will assume you are happy for your child to be screened. …………………………………………………………………………………………………………………… Vision screening at age 4 to 5 years Complete and return only if you DO NOT want your child to have vision screening. Name of child: …………………………………….……………..……… Date of birth: …..……………………… Address: ………………………………………………………………………..……………………………………………… Postcode: …………….………………………. I DO NOT want my child to have vision screening (tick box if appropriate) Signed (parent/carer) ……………………………………………………………………………………………….. Name in full (print clearly in capital letters) ………………………....…………………………………… Please return this reply slip to your child’s school by date in above format