Request for LVCC or LVCC+
Please complete this form to request a KanLovKids clinic for your student(s).
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Email *
Name of Student
Date of Birth
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DD
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YYYY
District Number
Student's Eye Doctor
Type of Clinic
Low Vision Collaboration Clinic (LVCC) is a clinical low vision evaluation, optical device trials and prescription for the devices, and instruction on how to use the device(s). A Low Vision Collaboration Clinic+ (LVCC+) is for infants, toddlers or school-aged children who have alternative communication and complex needs.
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Name of TSVI
Name of COMS
Name of Infant/Toddler Teacher
Notes/Comments
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