Request a Vision Screening

Please use our request form:

1. Access the Form: Click here to Open the online Screening Request Form  

2. Provide Your Details: Once the form opens, please fill in the required information:

   • Organization Name

   • Contact Name

   • Phone Number

   • Email Address

   • Best Time to Contact

   • Is This Request for One Site or Multiple Sites?

   • Anticipated Number of Children Screened?

   • Information Regarding Specific Date/Time Requests

3. Submit the Form: After filling out all the required fields, click the "Submit" button at the bottom of the form.

Thank you requesting a screening. We look forward to working with you!