{"id":643,"date":"2019-03-07T10:28:57","date_gmt":"2019-03-07T10:28:57","guid":{"rendered":"http:\/\/djcareservices.com\/?page_id=643"},"modified":"2019-03-07T10:28:58","modified_gmt":"2019-03-07T10:28:58","slug":"vision-assessment","status":"publish","type":"page","link":"http:\/\/djcareservices.com\/vision-assessment\/","title":{"rendered":"Vision Assessment"},"content":{"rendered":"\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f642-o1\" lang=\"en-GB\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/643#wpcf7-f642-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"642\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_GB\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f642-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label>Service User Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Service-User-Name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Service-User-Name\" \/><\/span><\/label>\n<\/p>\n<p><label>LL Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"LL-Number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"LL-Number\" \/><\/span> <\/label>\n<\/p>\n<p>Does this person have any visual difficulties?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Does-this-person-have-any-visual-difficulties\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Does-this-person-have-any-visual-difficulties[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Does-this-person-have-any-visual-difficulties[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Comments\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Comments\" \/><\/span> <\/label>\n<\/p>\n<p>Is this person registered blind\/partially sighted?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Is-this-person-registered-blindpartially-sighted\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Is-this-person-registered-blindpartially-sighted[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Is-this-person-registered-blindpartially-sighted[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Comments\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Comments\" \/><\/span> <\/label>\n<\/p>\n<p>Does this person wear glasses?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Does-this-person-wear-glasses\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Does-this-person-wear-glasses[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Does-this-person-wear-glasses[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Comments\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Comments\" \/><\/span> <\/label>\n<\/p>\n<p>Does this person use aids? (i.e. magnifying glass, talking book, Braille)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Does-this-person-use-aids\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Does-this-person-use-aids[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Does-this-person-use-aids[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Comments\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Comments\" \/><\/span> <\/label>\n<\/p>\n<p>Eye Care required? (e.g. use of creams)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Eye-Care-required\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"Eye-Care-required[]\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"Eye-Care-required[]\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><br \/>\n<label>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Comments\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Comments\" \/><\/span> <\/label>\n<\/p>\n<p><label>Supervisor Notes<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Supervisor-Notes\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Supervisor-Notes\" \/><\/span> <\/label>\n<\/p>\n<p><b>D&J Care Services undertakes that it will treat any personal information (that is data from which you can be identified, such as your name, address, e-mail address etc) that you provide to us, or that we obtain from you, in accordance with the requirements of the Data Protection Act 1998<\/b>\n<\/p>\n<p><label>Supervisor<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Supervisor\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Supervisor\" \/><\/span><\/label>\n<\/p>\n<p><label> Supervisor Signature<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Supervisor-Signature\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg\" aria-invalid=\"false\" type=\"file\" name=\"Supervisor-Signature\" \/><\/span><\/label>\n<\/p>\n<p><label>Date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Date\" \/><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v14.4.1 - 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