Updated: Replaced the pdf of the Certificate of Vision Impairment form with a version that can be completed on screen. Added OpenDocument Text version of the form.
The CVI form is issued to a patient assessed by a consultant ophthalmologist as being visually impaired. Please only use the current version. You should throw away any old stocks of earlier versions of the CVI.
The explanatory notes for ophthalmologists and hospital eye clinic staff explain how to complete and use the CVI form.
The Referral of Vision Impairment (RVI) letter template is for hospital eye clinics to use before a CVI is needed, or where the patient has declined registration but wants advice about the difficulties caused by loss of vision.
The easy read letter template can be used with the completed CVI form.
The plain text version may work better with patients’ screen readers than the form itself.
If you have any comments about using the form please email firstname.lastname@example.org.