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 up to 10 children. The form will automatically expand down the page as you enter each child. If you have more than 10 children referred from your center, you may submit the form multiple times, as needed, for each group of 10 children.
