Request A Screening

For more information or to request a KidSight screening please fill out the form below or call 855-4KIDSIGHT.

Screening Location
Select the office closest to your location.
Location Nearest You*
Availability
Give us a general idea of your availability for a screening. Please note that this is not a guarantee of a date for your screening, but be assured that KidSight will do our best to accommodate your organization.
First Choice*
MM slash DD slash YYYY
Second Choice
MM slash DD slash YYYY
Third Choice
MM slash DD slash YYYY
Tell Us About You
Organization Type*
Organization Name*
Address*
Street Address Address Line 2 City State ZIP Code
County*
Your Name*
First Last
Your Email*
Your Phone
For The Technician
Approximate Number Of Children To Be Screened
Additional Information

Screening Location