Now accepting applications for 2027 events. To request a VSP® Eyes of Hope® mobile clinic to provide free vision care for disaster relief or for a population in need who qualifies*, REVIEW THE EVENT TERMS AND CONDITIONS FIRST, then fill out this form. Questions? Contact us at mobileclinic@vsp.com. *Individuals must have a family income up to 200% of Federal Poverty Level guidelines and no coverage through a private insurer or government program for the vision care services to be provided. Income guidelines are waived during disaster response events.
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All fields required unless marked optional.
Contact Information
Mailing Address
Requesting Organization or Practice Information
*Other types of events where vision care will not be provided may be considered if our schedule allows.
A brief description of your event: Who will be helped, event details and event purpose, any additional organizations participating.
Event Start Date and Time
Requests made less than three months before an event will not be accepted. Events lasting several days for seven or more hours each day will be considered first.
Event End Date and Time
Note: The event location must be able to accomdate a mobile clinic up to the following specifications:
Length: 45’ Height: 13’6” Width: 12’ (parked); 8’6” (traveling) Weight: 46,000 lbs
All fields are required unless marked optional.
*Eligibility All services are offered on a first-come, first-served basis, for individuals who meet the following qualifications:
I have reviewed the Mobile Clinic Event Partner Terms and Conditions and understand that submitting this request does not guarantee approval or reserve an event date. If the request is approved, my organization and any separate event-location host must complete VSP’s required agreements in a timely manner. The event will not be confirmed on the calendar until the documents are signed.
I have disclosed whether a school, district, public entity, or host requires VSP to sign a Memorandum of Understanding (MOU) or other terms and understand that VSP must be permitted to review and reasonably revise those documents before the event can be confirmed.