Request a Screening Kit

If you’d like to order a vision screening kit, please fill in the fields below and an Elks representative will contact you.

Name:

Address:

City:

State/Zip Code:

Zip Code:

Home Phone:

Work Phone:

Contact Email:

This is the email address we will use to notify you when ready for pick-up.

Contact Preference:

Home Phone

Work Phone

Email Address

Which vision screening kit would you like to order?

Preschool Vision Screening (Age 3-5)

School Age Vision Screening (Grade K - 12)

Combination Kit (Ages 3- 18)

Vision Screening Kit Replenishing Supplies

Comments:

Please let us know if you have any comments or questions.

Learn More

Vision Screening Kit Cover