Client Referrals

POLICY AND PROCEDURES

Making It Visible INC.’s mission is to provide appropriate services in Assistive Technology for consumers who are Blind/Visually Impaired. These services include Assistive Technology instruction, training, and consulting for Blind and Low Vision children and adults. In addition, Making It Visible INC. also provides in-service/professional development training on instructional/adaptive strategies and assistive technology
implementation for individuals working with Blind or Low Vision clients/students.

REFERRAL PROCESS

When requesting Client Training Services through our company, the referring counselor must provide the following information:

• Completed Making It Visible INC. Referral Form (which can be found on page 3)
• Client Eye Report
• Current AT Evaluation

ALL referred clients must have a current AT Evaluation (within the last 2 years) to be considered for AT Training Services. If the client does not have an updated AT Evaluation, you may request this service on the Making It Visible INC. Referral Form.

CLIENT ATTENDANCE

We hope that clients will attend each scheduled training session. To ensure that our AT Specialists and clients meet the expected standards, the following policy will be implemented:

• Client must contact the AT Specialist at least 12 hours in advance for a Cancellation/Reschedule of AT Training Services.
• If a client does not contact the AT Specialist in advance, he/she will be noted as a NO SHOW.
⁃ The referring counselor will be notified of each Cancellation and No Show
⁃ After 2 NO SHOWS, the client services will be interrupted until further notice.

AT TRAINING SERVICES

The AT Specialists of Making It Visible INC. are qualified individuals in the field of instructional training for people with visual impairments. Each AT Specialist will provide 2 - 3 hours of weekly AT Training. In addition, after each session, a formal report will be submitted, indicating the session goals, topics, summary, and next steps. You will receive a copy of the Client AT Training Report at the end of each week.

CLIENT RERERRAL FORM

REFERRING COUNSELOR INFORMATION

Referring Counselor's First Name

Referring Counselor's Last Name

Referring Counselor's Phone Number

Referring Counselor's Email

CLIENT INFORMATION

Client's First Name

Client's Last Name

Client's Date of Birth (mm/dd/yyyy)

Client's Address (Line 1 of 2)

Client's Address (Line 2 of 2)

Client's City

Client's State

Client's ZIP Code

Client's Phone Number

Client's Visual Impairment

Client's Background Information

ADDITIONAL DOCUMENTATION

Please provide the most current diagnosis, eye report and Assistive Technology Evaluation. Use the button below to add these documents. Documents must be in PDF file format. Documents will be added to your secure email once you click the Submit button.

REQUESTED TRAINING SERVICES (Check all that apply)

AT EvaluationScreenreaders (NVDA, Fusion, ChromeVox, JAWS, and MAC Voiceover)Mobile Screenreaders (Android & iPhone)Screen Magnification (Windows Magnifier and ZoomText)Google Extensions for Low Vision UsersRefreshable Braille DisplaysHandheld Magnifiers and Digital MagnifiersCCTVsPortable Artificial Devices (OrCam My Eye)Reading DevicesMeta Ray Ban Smart GlassesAdapting Materials for Low Vision and Braille usersGoogle SuiteMicrosoft Office 365AT EvaluationsIn service and professional development training

TRAINING OPTIONS (check all that apply)

RemoteIn-PersonHybrid

AUTHORIZATION INFORMATION

Authorization Number

Number of Authorized Training Hours

ACKNOWLEDGEMENTS

I have read and understand the Policies and Procedures presented by Making It Visible INC.

As the referring counselor, I will uphold the expectations presented by Making It Visible INC. and communicate these expectations to the client.

REFERRING COUNSELOR'S SIGNATURE

Counselor's Signature (Required)

Date Signed (Required)