Become a Referral

VISION USA partners with over 3,015 referral agencies and more than 2,917 AOA member optometrists who donate their services to provide eye exams to low income uninsured U.S. citizens each year. Their efforts have impacted the lives of more than 430,000 individuals by providing eye care that would not otherwise be possible.

VISION USA depends on referral agencies across the country to connect us with those in need. Applications must be submitted electronically with verification from a referral agency that has registered with the program.

Community Action Groups, Social Service Agencies, Community Health Agencies, GoodWill, Salvation Army, United Way, Lions Clubs, primary care physicians, school nurses, charitable and religious organizations are all examples of commonly registered referrals.

To become a registered referral agent with VISION USA please complete a one-time Referral Agency Access Form by clicking the button below:


Referral Agency Instructions:

  • Complete a REFERRAL AGENCY ACCESS FORM and receive your Referral Agency Access Link.
  • A response will be emailed within 24-48 hours with a hyperlink to the online application form.   
  • Complete an application APPLICATION FOR VISION USA SERVICES 2017 with your client.
  • Use the Referral Agency Access Link to submit application electronically.
  • Within 2-4 business days you will receive email doctor assignment. Provide copy of email to client within 10 days of receipt.
  • If no response is received within 5 working days, email our offices at
  • Client to call and schedule their VISION USA appointment within 45 days.

To contact VISION USA, please send an email to


Your investment will ensure that The AOA Foundation continues to provide immediate relief to those in need in the wake of natural disasters, vision care to needy Americans, scholarships for optometry students, preservation of optometry’s history and public education about the need for a lifetime of vision care.

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