A Shared Vision is piloting a multiplatform solution for the Parent Questionnaire© using CognitoForms

In response to community feedback for a more user-friendly experience, A Shared Vision is launching a multiplatform pilot for the Parent Questionnaire©.

While our Vision Screening Protocol© has traditionally been accessible via PDF, the introduction of CognitoForms now enables caregivers to effortlessly access, view, and fill out the Parent Questionnaire© on any device—whether it's a smartphone (iPhone or Android), tablet, or computer.

How It Works

Send a link to caregivers through an email or text to access the Parent Questionnaire©. It's available in English and Spanish!

Caregivers open the link on any device, fill out details about their child's vision, and then get a copy of their answers in a PDF by email. They can share the PDF with a pediatric eye doctor if a referral is needed.

Completed questionnaires can be viewed on your CognitoForms dashboard. You may also receive email notifications when new forms are completed.

How It Looks

Caregivers can easily navigate the Parent Questionnaire©, which automatically adjusts its format to suit any device. Click HERE to view an example of the questionnaire in English; HERE for Spanish.

HIPAA Compliance & PHI Protection

Through an Enterprise license, our use of the CognitoForms platform adheres to both US and international regulatory standards, including HIPAA, GDPR, and CCPA, and is compliant with ADA guidelines for online accessibility. Their security protocols meet the highest standards, utilize the latest technologies to ensure protected data remains private, safe, and secure. To learn more, click HERE.

You can view our Business Associate Addendum with CognitoForms and our Data Processing Addendum for further details.

In addition, we highly advise that any organization wishing to take part in the multiplatform pilot enter into a Business Associate Agreement with us. You can find a sample agreement HERE. For organizations that already have a signed BAA with us, HERE is a sample addendum to extend our support as you implement this new solution.

For more information or to discuss participation in the pilot, contact us at [email protected].