Children and Families: Make a referral to the Visual Impairment Team

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Instructions page

Please use this form to make a referral to the Visual Impairment team.

Before you start

You'll need:

  • child's medical and personal details
  • parental/carer consent
  • parents details

Unless the referral is for a known Vision condition or concerns around visual processing of information (CVI), an appointment at the opticians to rule out the need for glasses is recommended before referring to the Visual Impairment Team.

This form will time out after 10 minutes on one page.