Accessibility Tools

Assistance Application

Please fill out the application below to apply for assistance with vision issues.

Our Vision Outreach Director will contact you within 5 business days to schedule an appointment. You will be responsible for your own transportation and must be on time to avoid scheduling conflicts. Contact our office 24 hours in advance to cancel or reschedule your appointment, missed appointments may not be rescheduled and may further disqualify you from receiving assistance through Friends for Sight.

Eligibility Requirements:

  • Have an income below established guidelines based on household size (at or below 200% of the federal poverty guideline)
  • Have not received services through Friends for Sight in the past 12 months

English, Spanish, Other
Insurance ID #, etc.
Drag and drop files here or Browse
If you only need help with glasses attach a copy of your current prescription.