If you would like to refer your blind or visually impaired patients for our orientation & mobility training and guide dogs, please complete and return our form to us through post, fax or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it

If you would like to email us the form, please fill out the Microsoft Word version and send it to us. Click here for the PDF version.

We will contact your patient directly upon receiving the form.