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Glasses Assistance Program

Low Cost Optical Department:

Vision Services offers glasses at low cost to individuals who meet income guidelines of the program. A current eyeglass prescription is required (within two years). 

An application can be filled out here or at our office. Applications can be mailed in, or dropped off in person. We charge a $15 processing fee due at the time of glasses fitting. All glasses fittings are by appointment only. If eligible for our assistance program, you can receive up to $125 per person for glasses. Inquire for more details or if you have questions. Monies are used for glasses available at VSOWG or we will pay directly to your eye care providers practice, we CANNOT reimburse or pay to the applicant. 

For those who get glasses here, your application must be approved before the glasses are sent out to be made. Income verification is required prior to your application being approved. We will not send out glasses until the application is completed and approved. The glasses usually take between 2-3 weeks (from fitting)  to come back depending on mail and holidays.  

*We follow Federal Poverty Income guidelines up to 300% for individuals and families.

Glasses Application 2025   

Click above for the application, or call and we can mail a copy. You may also pick up a copy in person. 

Is Applicant an adult or child?
Does applicant have insurance?
Do you have extenuating financial circumstances that affect your ability to pay for eye care?

Please list Name, Birthdate and relationship to applicant

Please list Name, Birthdate and relationship to applicant

Please list Name, Birthdate and relationship to applicant

Please list Name, Birthdate and relationship to applicant

Please list Name, Birthdate and relationship to applicant. If more than 5 family members add them to this box.

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By signing you understand that you must complete this application to the best of your ability, and provide documentation requested for financial verification. Eligibility is based on 300% of the federal poverty level.

Contact

724-228-0770

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