California School for the Blind
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ASSESSMENT ASSISTIVE TECHNOLOGY LOW VISION CLINIC


CAUSES OF L.V.
| EYEBALL CLASSES | CLINIC REFERRAL | CONSULTATION

Low Vision Clinic Referral


What CSB’s clinic offers:
*free of charge comprehensive low vision exams by UC Berkeley optometrists
*students receive free optical devices including magnifiers, monocular telescopes, and sunglasses, if appropriate
*demonstration of electronic magnification devices and lighting options with students
*team discussion about maximizing the student’s use of vision in the classroom and community
*detailed written report summarizing findings and recommendations from the exam

Who can receive an exam?
*low vision students who qualify for vision services in California schools
*students must be able to respond to verbal directions and questions in a clear manner (this can be through gestures, pointing, etc.)
*students ages 5-22 years old, eligible every 2-3 years

How to register:
Submit a complete referral packet including the following items:
1. Low Vision Clinic Referral Application
2. Patient Information Form
3. Permission Form
4. Vision Report from eye care professional (optometrist or ophthalmologist)
5. IEP Cover Sheet, noting that the student qualifies for vision service



We require that the student’s TVI or O&M instructor accompany the student to an exam. Families and IEP team members are encouraged to attend.

To refer students to the CSB Low Vision Clinic, please complete the documents in the link below and attach them to the eye care professional’s report and the IEP cover sheet.  Once all of the elements are collected, please submit them to the contact below.

 

CSB Low Vision Referral Packet

CSB Low Vision Referral Packet (Spanish)-(CSB - Paquete de Remisión – Clínica de Visión Baja)

 

Submit referrals to Shelby Zimmerman:

By email: szimmerman@csb-cde.ca.gov
By fax: (510) 794-3993
By mail: California School for the Blind
500 Walnut Ave
Fremont, CA 94536

 

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