Your hearing & vision intake form.

Hearing & Vision Screening — Offline
Screener: — Round 1 Screened: 0 ● not connected Open Sheet ↗

Hearing & Vision Screening

Live mode — connected to your Google Sheet. Several screeners can work at once; every saved screening writes to the sheet in real time.

STEP 1

Connect & sign in

Paste the Web App URL from your deployed script (it ends in /exec).
Please select or enter a screener name.
STEP 2

Roster from your Google Sheet

Connecting…

open the Google Sheet ↗
STEP 3

Screen a student

HEARING
Required.
Select at least one.
Required.
500 Hz *1000 Hz2000 Hz4000 Hz
Right Ear
Left Ear
Right & Left 500 Hz are required.
Select at least one.
VISION
Vision & color were completed in Round 1 — locked for Round 2. Re-screen hearing only; this student's vision stays as recorded on the R1 tab.
Required.
Required.
Required.
Diopter Sphere *Diopter CylinderAxis *
OD (Right)
OS (Left)
Sphere & Axis (both eyes) and OD Cylinder are required.
Acuity - Right *Acuity - Left *Nearsightedness *
All three are required.
COLORrequired for boys in 1st & 2nd grade
Required for boys in 1st/2nd grade.
Please complete the required (*) fields above.

Screened this session

No students saved yet.

Open the Google Sheet ↗

Every saved screening writes straight to your Google Sheet. This list shows what you entered on this device; ⟳ becomes ✓ once the sheet confirms it.