Vision Clinic

Friends for Sight provides free eye exams and prescription glasses to those who qualify.

To be eligible for our program, your household income must be at or below 200% of the federal poverty guideline.

After submitting the form, we kindly ask for your patience as we review the numerous applications received at our office. Rest assured, someone from our team will reach out to you within 5 business days.

In case of eye emergencies like sudden vision loss, severe pain, trauma, or unusual symptoms like flashes and floaters, seek urgent medical attention at the nearest emergency department. Prompt evaluation is crucial to prevent vision loss and complications. Don't delay—act swiftly to safeguard your vision health.

Your name *

Phone *

Email address *

Home address *

Date of Birth *

Services Needed *

Eye Exam & Glasses

Glasses only

Preferred Language *

English, Spanish, Other

Have you received services through Friends for Sight in the past? *

YES

Do you have private or government insurance including Medicaid/Medicare? *

YES

Have you received an eye exam in the past 12 months? *

YES

Number of people living in your household? *

Monthly Household Income *

Additional information *

Insurance ID #, etc.

Glasses Prescription

Drag and drop files here or Browse

If you only need help with glasses attach a copy of your current prescription.

First Name