Opening Eyes Event Evaluation

Opening Eyes Event Evaluation

Please return this form within 2 weeks of completion of your event

Event details

SO Program name*

Region*

Select or enter value

Event Location*

Name of the Clinical Director*

CD leading this event

Funding

Have you applied for or received funding from SOI for your event?

Select or enter value

Start date of the Opening Eyes Event*

End date of your Opening Eyes Event*

Summary of Athletes served

Total number of individuals screened*

A completed screening: All stations have been reviewed at Final Check-Out (where refraction may have been recommended).

Place the athletes have been referred to

Total number of urgent referrals*

Place the athletes were referred to for treatment

Number of prescription Dress Eyewear prescribed*

All Rx eyewear except sport goggles

Number of prescription Sport Goggles prescribed*

Lab services/Lenses provided by OneSight Essilor..*

Indicate if you used OneSight EssilorLuxottica Fdn. (formally Essilor Vision Foundation) lab or stock lenses/services.

Select or enter value

Other Lab

If you received prescription lenses and/or services from a lab or provider other than OneSight EssilorLuxottica Fdn. please indicate.

Number of Plano Sunglasses dispensed*

Summary of volunteers who participated

Number of optometrists who participated*

Number of ophthalmologists who participated*

Number of opticians who participated*

Number of ophthalmic technicians*

Number of optometry students participating*

Number of ophthalmology residents participating*

Number of Lions / Leo Clubs volunteers*

Number of general volunteers*

Additonal Event Information

Event Success Stories/Summary

Please share any athlete stories or a summary statement from your event. This can be a statement or quote from a partner, athlete, volunteer or coach etc. Use the text box below to share additional content. Special Olympics may ask to use your story to publish, make sure you have consent from athletes/caregivers/volunteers that their stories can be used.

Event Photos*

Please upload any accompanying pictures from your event. Special Olympics may ask to use your photos to publish, make sure you have consent from athletes/caregivers/volunteers that their pictures can be used. If you do not have photos from your event, please provide a statement or quote from a partner, athlete, volunteer, or coach, etc. and upload a document containing that to complete this required field.

Drag and drop files here or

Additional Information you want to share

Please use the text box to share further information and comments about your event incl. links to articles, press releases, videos or links to additional photos of your event

Send me a copy of my responses

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