Call Trumbull 203-457-8554
Call Stamford 203-457-8779
Call Norwalk 203-408-9888
Call Southport 203-457-8669
Call Mahopac 845-628-3750
Call Mt. Kisco 914-241-2020

Call Trumbull 203-457-8799
Call Stamford 203-457-8744
Call Norwalk 203-457-8544
Call Southport 203-457-8663
Call Mahopac 845-628-3750
Call Mt. Kisco 914-241-2020

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Home » Sports Vision Screening Registration Form

Sports Vision Screening Registration Form

sports vision screening

Fill out this form to be registered for our ECA Sports Vision Screening Day scheduled for June 12th from 11:00am – 1:00pm at our Southport Location.

Are you filling this out for a child?
- Yes
- No
Name of Child*
First Last
Name of Parent or Guardian*
First Last
Name*
First Last
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
Name of School and Grade*
First Last
Which sport(s) are you currently participating in?*
- Baseball
- Soccer
- Football
- Basketball
- Hockey
- Lacrosse
- Field Hockey
- Tennis
- Golf
- Volleyball
- Swimming
- Gymnastics
- Other
What other sport(s)?
What level are you currently at in sports?*
- Beginner
- Intermediate
- Advanced
- Professional

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EyeCare Associates – Located at 6515 Main Street, Suite 12, Trumbull, CT 06611. Phone: 203-374-2020 . https://cteyecareassociates.ecpbuilder.com

EyeCare Associates – Located at 1425 Bedford St, Stamford, CT 06905. Phone: 203-357-0204 . https://cteyecareassociates.ecpbuilder.com

EyeCare Associates – Located at 444 Westport Ave, Norwalk, CT 06851. Phone: 203-840-1991 . https://cteyecareassociates.ecpbuilder.com

EyeCare Associates – Located at 2600 Post Rd, Southport, CT 06890. Phone: 203-255-4005 . https://cteyecareassociates.ecpbuilder.com

EyeCare Associates – Located at 572 Route 6, Mahopac, NY 10541. Phone: (845) 628-3750 . https://cteyecareassociates.ecpbuilder.com

EyeCare Associates – Located at 103 So. Bedford Rd. Suite 101 Mt., Kisco, NY 10549. Phone: (914) 241-2020 . https://cteyecareassociates.ecpbuilder.com

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Call Trumbull Location
203-457-8554

Call Southport Location
203-457-8669

Call Norwalk Location
203-408-9888

Call Stamford Location
203-457-8779

Call Mahopac Location
845-628-3750

Call Mt. Kisco Location
914-241-2020