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    Clinic Support Request

    Contact Us
    Mission Dates: (required)
    (Example: 5/21/2010)
    (Example: 5/21/2010)
    U.S. Delivery Street Address:





    Primary/Mobile Phone:

    The first 300 readers and 100 sunglasses will be provided at no cost.

    * You will receive your handheld autorefractor 1-2 weeks before you depart for your mission trip and must send the handheld autorefractor back to National Vision the week you return. This is to ensure that NVI is able to maximize accommodation of requests.

    In return for the items NVI donates/loans to your trip, we request that you share stories, photos and data (# of patients seen, # of glasses distributed, etc.) with us upon your return.

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