FREE EYE EXAMS AND GLASSES!!

Dear Parent or Guardian, your school is partnering with Vision To Learn (VTL) to provide vision services this school year! Recently your student received a vision screening that identified that your child needs an eye exam. Vision To Learn’s mobile vision clinic will now visit your student’s school campus to provide that eye exam and, if needed, glasses. Good vision is important for your child to do well in school.

Vision To Learn Program Description:
Examinations: Students will receive an eye exam from Vision 4 Students, PC, an independent optometry practice which partners with Vision To Learn on VTL's mobile clinic—without dilation or eye drops. If glasses are needed, students can choose frames at the clinic and take home a glasses prescription. If further care is needed, the doctor will contact you.
Glasses: If the doctor prescribes glasses, your student will: 1) Choose a frame from a wide selection, 2) Receive a copy of the glasses prescription to take home, and 3) Obtain the glasses at the school, from a trained VTL optician, about one month after the exam. If students lose or break their glasses, VTL will replace them at no charge during the lifetime of the prescription.

Medicaid Benefit Usage
Receiving vision services provided by this program will constitute a comprehensive eye exam and – as needed – eyeglasses and dispensing of glasses that may be billed to your child’s 2026-27 Medicaid benefits, if applicable. Please note that a no-cost eye exam and eyeglasses will be provided even if your insurance cannot be billed. You may receive a notice called an Explanation of Benefits (EOB) from your insurance carrier with information regarding the services billed and the payments that have been approved, but you will not receive any bill for the services or eyeglasses.

Student Information for Vision Services
To coordinate services and manage health records, your school district will share the following information with Vision To Learn: Child’s Full Name, Date of Birth, Sex at Birth, Parent/Guardian Full Name, E-mail, Phone Number, Teacher, Grade, and Student ID Number. Vision To Learn may use this information to identify if your student has available Medicaid coverage, and submit claims for vision services provided to your student, if applicable. Additionally, Vision To Learn will share your student’s vision exam results with your school district.
To enroll your student in VTL’s program, please complete the required information below for each student in your household. Services will be provided on scheduled dates at each site. For more information, contact your child’s school or VTL.
Please have your student return the completed form to their teacher

By signing this form, I agree to allow my child to receive a vision exam and glasses, if indicated, by the independent optometrists with Vision 4 Students, PC, and I authorize the release of my child’s health information to these optometrists and to Vision To Learn for the purposes described above. I hereby acknowledge that I have the right to refuse any services provided by Vision To Learn but that I am choosing voluntarily for my child to receive vision services. These services include an eye examination and a pair of prescription glasses if needed as described above. I understand that these services are non-invasive and will occur at my child’s school coordinated with my child’s school district. My signature shows that I have read and understood this voluntary Consent and Release and I agree to its provisions.