Failed Referral Letters

Ensure proper follow-up care after a failed vision screening.  Use the Vision First referral letters and report forms.  


For Preschool


For Grades K-12


Vision First referral letters are key

These prewritten referral letters were created for schools participating in a vision screening program. 

We are confident parental compliance will increase following a failed vision screening when using the Vision First Vision Screening Referral Letters.

For easy identification, each letter has its name in the lower-left corner.  The names of the attachments are included.


Join the campaign today

The Vision First Kids Eyes Count Campaign needs to be approved by your school or school district before any letters or documents are distributed. 

For information regarding a school’s participation in the campaign, please review the Proposal for Schools.

Please follow the A+ Action Plan for Schools.  It is an excellent guide.  For more information, please visit FAQ.


Follow these simple instructions:

  • Choose preschool or grades K-12.
  • Choose Part One for the children who fail the vision screening.
  • Choose Part Two for the parents who fail to submit a completed vision report signed by an eye doctor within 60 days after a failed vison screening.
  • Insert your name, school, the school’s phone number, and the approval information in the gray/blue highlighted sections of the prewritten letter. (The Referral Letters also allow you to insert the child's name and the date, if desired.)  
  • Print your copies.
  • Distribute the referral letter and attachments as shown in the A+ Action Plan for Schools.  We made it simple for you.  Each letter has its name in the lower left corner with the name of the attachments included. 


Recommended attachments

The Preschool and Student Comprehensive Eye and Vision Examination Report should be included with this referral letter.  The Vision First report forms exceed state standards.

The optional Reference Page explains the Vision First reports and can be included with an optional Vision First fact sheet, too. 

Remember, successful treatment for the child depends on parent compliance and cooperation from the school.


"Each today, well-lived, makes yesterday a dream of happiness and each tomorrow a vision of hope.  Look, therefore, to this one day, for it and it alone is life."
—Sanskrit Poem

Ensure proper follow-up care after a failed vision screening.  Use the Vision First referral letters and report forms.

"For Illinois" versions here

If you live in Illinois, use the Vision First report forms and prewritten letters made for Illinois. These documents reference Illinois law. View "For Illinois" here...

Check your printer's setting

For full size copies, make sure your printer's print setting for "scale to paper size" is set for "no scaling."


For further information, please visit FAQ...

Questions? Comments? Need help?  Please contact us here...

We hope you'll join our campaign!