Refer a Child in Need of Eye Care, Eye Exams or Eye Glasses to JVQ

If you don't have a username and password, please fill out the form below and we will send you a password upon referral verification within 24 hours.

Your username will be your email address.

Name:
School or Health Dept.:
Phone:
E-mail:
Address:
City:
State:
Zip Code:

"God made wonderfull thinks that I can not see well and also made wonderfull people who help me see all the world when they gave me a nice present "my glasses". Know that I can see this beautifull world, I pray the Lord for all of the people who made it possible. God Bless you for ever and thank you very much."

Santiago Chaparro

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