BESB: BESB SELF REFERRAL FORM

BESB SELF-REFERRAL FORM

 

If you believe that you or your child meet the Eligibility Criteria for services, please email us at brian.sigman@ct.gov or call 860-602-4000. 

 

An eye report from your doctor will be required to verify your visual information.

 

Please contact us if you are the individual who is legally blind or the parent or guardian of an individual who is legally blind.  Third parties may not refer individuals they believe may be legally blind.

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All that is needed to become a BESB client is an eye report signed by an eye doctor. All the report needs to include is:

  1. best corrected acuities in the better eye

  2. eye diagnosis

  3. name

  4. address

  5. phone

  6. date of birth

  7. Social Security number

  8. Contact person & phone number, if appropriate

 

There is no “application” as such. All information is kept confidential.

 

Eligibility

Adults:  20/200 corrected in better eye OR a field restriction of 20 degrees or less. Adults must be deemed legally blind in order for BESB to provide services. Visually impaired adults are referred to BRS.

 

Children:  Services can be provided for visually impaired (VI) OR legally blind (LB) children.  Visually impaired is 20/70 to 20/200 in the better eye.





Content Last Modified on 6/22/2011 10:40:42 AM