Eyelook Questionnaire

Parent Questionnaire: It would really help us if you answer the following questions. Your completed form will be emailed to the school office. Thank you.

Name of child*

School: St James' Church of England Primary School, Old Jamaica Road, London SE16 4SU

NHS Number (if known) Date of Birth (format **/**/****)*

1. At this time, is your child under the care of an eye clinic?*NoYes: Hospital eye clinicYes: High street optician

If you have any concerns about your child's vision, please give details below

It is important to have children's vision tested, even if everything appears OK.

If you DO NOT want your child to be tested, tick this boxI do NOT want my child to be tested.

Please enter your full name and date to show you have completed this form

If we do not receive this form, or the form is incomplete, we will assume you DO wish to have your child's vision assessed and are happy for the school to provide details of your child's address, telephone number and GP details.

Parents

Eyelook Questionnaire

Contact Details and Quick Links