DOWNLOAD FORMS
Online Referral Form
Please complete the CLVP referral form. This is the first step in the referral process before a student can be approved for a clinic spot. You will be required to attach the student's most recent clinical vision assessment reports (must be within last 2 years) in a Word or PDF document.
Download the CLVP Referral Form
Download the CLVP Referral Form
Student Forms
CLVP team will contact you once your student has been accepted into one of our clinics.
Once your student's spot has been confirmed, you will be required to fill out the Student forms below.
These forms can be completed online, saved and submitted, or can be downloaded, printed, and submitted by email.
Please DO NOT mail these forms.
Please ensure your CLVP clinic placement has been confirmed before you download and fill out the forms.
The online referral form must be submitted first to determine eligibility. This can be done at any time.
All forms are due back to the CLVP team three weeks prior to the clinic date (clvp@prcvi.org)
Failure to return forms fully completed by the due date requested, may result in the clinic spot being given to another student
on the waitlist.
Each child requires the following completed Clinic Forms
Once your student's spot has been confirmed, you will be required to fill out the Student forms below.
These forms can be completed online, saved and submitted, or can be downloaded, printed, and submitted by email.
Please DO NOT mail these forms.
Please ensure your CLVP clinic placement has been confirmed before you download and fill out the forms.
The online referral form must be submitted first to determine eligibility. This can be done at any time.
All forms are due back to the CLVP team three weeks prior to the clinic date (clvp@prcvi.org)
Failure to return forms fully completed by the due date requested, may result in the clinic spot being given to another student
on the waitlist.
Each child requires the following completed Clinic Forms
- Educator form
- Parent form
- Consent form
- Medical form - Please note, as of September 1, 2023 the use of the CLVP Medical Form has been discontinued. Please submit an ophthalmology report (dated within the last two years) with other clinic forms.
- Video/Photo Release