Online Low Vision Seminar
•
Refer to the online seminar on the
course page
.
*Complete Name:
*Street Address:
City:
State:
Zip:
*Email Address:
*Phone Number:
Select Product Below
:
Low Vision Assessment Form
Low Vision Home Assessment
Reading Acuity Card
ADL/IADL Checklist
Payment Method:
Credit Card
:
Master Card
VISA
Discover card
Number:
Expiration:
/
Print out Order, fill out Form and Mail or Fax with credit card information
Payment can also be made by phoning 409-363-3960
Money Order
Check
Credit Card Information
(including number and expiration date.)