Thank you for playing a critical role in our mission to prevent blindness and preserve sight! By providing the contact information of the children that did not pass our vision screening at your location, we are able to follow up with the families and make sure that the child gets any needed care or treatment for their vision.
You can use this page to quickly enter referral contact information for a small group of children. The form below will allow you to submit only 4 children currently. If you have more than that referred from your center, you may submit 4 at a time with no limit on the number of submissions. In the near future, this form will allow up to 10 children at once.
