Every child admitted for the first time to a Georgia public school needs this certificate showing four screenings: vision, hearing, dental and nutrition. Pediatric clinicians meet it at a school-entry visit, since the child's doctor may perform all four. The parent files it with the school at enrollment, and it is filed only once: if the child later transfers, the first school forwards it to the new one.
Each of the four sections is signed by whoever did that screening, certifying it was completed or attempted, with contact information. The child's doctor or the local health department may do all four; optometrists, audiologists, speech-language pathologists, dentists, dental hygienists, dietitians and school nurses may do matching sections. Parents fill in the child and contact details.
Enter the child's first, middle and last name, date of birth and gender, then the parent or guardian's name, home address and primary and secondary phone numbers. The form states that screener contact information is required as well, so each screening section below also carries the screener's contact details.
Note whether the child uses corrective lenses and whether they were worn for testing. Select one method: a distance visual acuity chart (primary), passing at 20/50 for age 3, 20/40 for ages 4 and 5 and 20/32 for age 6 and older, or an instrument-based photoscreener (alternative). Mark the result as passed both eyes, failed and needs further evaluation, under professional care or unable to complete, then check who screened, sign, date and add contact information.
Check if the child uses a hearing aid or assistive device; if so, do not screen. Select pure tone audiometry at 1000, 2000 and 4000 Hz at 20 dBHL (primary) or automated otoacoustic emissions (alternative). Mark passed both ears, failed and needs further evaluation, under professional care or unable to complete. Check physician, audiologist, local health department, speech-language pathologist or school nurse, then sign, date and give contact information.
Mark one result: normal appearance, needs further evaluation, emergency problem observed, under professional care or unable to complete screening, explaining the last two in comments. Check who screened: physician, dentist, local health department registered nurse, registered dental hygienist or school registered nurse. Sign and date to certify the screening was completed or attempted, and add contact information.
Record height, weight, BMI and BMI percentile, then check the category: 5th to 84th percentile, appropriate for age; below the 5th percentile, needs further evaluation; 85th percentile or above, needs further evaluation; under professional care; or unable to complete. Check physician, registered dietitian, local health department or school nurse, then sign, date and give contact information.
The primary method is required when developmentally appropriate; the alternative may be used only when it is not, and the reason goes in comments. DPH's guidance adds that photoscreeners are not for age 6 and older and aOAEs are not for children at risk for auditory neuropathy, such as a NICU history. Use comments as well for failed screenings, children under professional care and any screening that could not be completed.
Download the current version from the source each time; forms change without notice.
Certificate of Vision, Hearing, Dental, and Nutrition Screening
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The child's doctor or the local health department can do all four screenings. Vision can also be screened by an optometrist, a trained Prevent Blindness Georgia employee or a school registered nurse; hearing by a speech-language pathologist, audiologist or school nurse; dental by a dentist, dental hygienist or school nurse; and nutrition by a dietitian or school nurse. One person need not do all four.
No. The form is filed only once, when the child is first enrolled in a Georgia public school. If the child later transfers, the original school is required to forward the Form 3300 to the new school, so a new set of screenings is not needed for the transfer.
For distance visual acuity, the form's pass levels are 20/50 at age 3, 20/40 at ages 4 and 5, and 20/32 at age 6 and older, each eye screened separately. For pure tone audiometry, the child must respond at 1000, 2000 and 4000 Hz at 20 dB HL in each ear.
Mark Unable to complete screening in that section, explain the reason in the comments, and refer if any concern exists, as DPH's screening tool guidance directs. If the child cannot manage the primary vision or hearing method, the alternative instrument-based method may be used, with the reason documented in comments.