Parent Feedback

Please enter the id number from your child's blue screening referral card or vision screening certificate (xxxx-xxxx).*

Email Address

Was your child referred for an eye exam as a result of this screening?*

If "yes" – did you, or do you plan to, make an appointment for an eye exam for your child?*

Overall, how pleased are you with this vision screening program?*

Have you (the parent/guardian) ever had an eye exam?*

Do you visit the eye doctor regularly?*

Do you want a conexus program staff member to contact you?*

Additional Comments