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* 1. Completed by (Name/ Trust/Email address):

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* 2. Is vision screening in your area commissioned by:

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* 3. If you know the name of the Director of Public Health in your area please state below with contact details (email/tel) if known:

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* 4. Which local authority /authorities would you approach to commission ‘orthoptic led vision screening’ from your trust?

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* 6. If you have answered ‘Yes’ to any of the above is this service commissioned by the local authority/CCG/unknown


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* 7. If you answered ‘No’ or ‘don’t know’ to the options in Q 5 do you want to be involved in the commissioning of ‘orthoptic led vision screening’ in the area your trust covers?

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* 8. Are you aware of the guidance published by Public Health England on vision screening?


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* 9. If you have answered yes to Q 8 , do you think it will be used in your area to:

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* 10. Are you a member of the Local Eye Health Network (LEHN)?

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* 11. Do you attend any Health and Wellbeing board meetings?

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* 12. Would you consider becoming a member of the LEHN?

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* 13. If No/Maybe to Q 12 please explain why below:

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* 14. If you attend any of the above or any other local committee please give a description of your involvement and any impact it has had on vision screening services.

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* 15. Are you happy with the level of information you provide to BIOS for the national vision screening audit?

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* 16. Do you use the current information to benchmark your vision screening service?

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* 17. Would you be prepared to provide more detailed information for the audit

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* 18. If yes:

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* 19. Is there additional information that you would like to have in the audit to allow you to benchmark your service? Please state:

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