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IScreen Consent Form - University of Iowa - medicine uiowa

IScreen Consent Form - University of Iowa - medicine uiowa 2026

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The Iowa KidSight Consent Form is designed for parents to authorize their preschool-aged children to participate in a free vision screening conducted by local Lions Clubs in collaboration with the University of Iowa Children's Hospital. The screening aims to detect various eye disorders without physical contact or the use of eye drops. Participation is voluntary, and a signed consent form is required for each child. The document outlines the purpose of the screening, confidentiality assurances, and the responsibilities of parents regarding follow-up care.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date of screening at the top of the form. This is essential for record-keeping.
Indicate whether your child is currently seeing an eye doctor by checking 'Yes' or 'No'. If 'Yes', provide the name and city of the eye doctor/clinic.
Fill in your child's personal information, including their full name, date of birth, and age. Ensure accuracy as this information is crucial for identification.
Complete the parent’s contact details, including home, work, and cell phone numbers, along with an email address for communication regarding screening results.
Read through the consent statements carefully. By signing at the bottom, you grant permission for your child to participate in the screening event.
Finally, ensure you date your signature to validate the consent form before submission.

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Versions	Form popularity	Fillable & printable
2017	4.7 Satisfied (48 Votes)
2015	4 Satisfied (39 Votes)

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