Mission Support Request

About You

Required fields are marked with an asterisk (*).

Mission Dates

All orders need a minimum of two weeks to process.

Request Sunglasses *
Request Handheld Autorefractor Loaner *
US Delivery Address
Is the shipping address a residential one?
Are you a non-profit? *
Type of mission *

By submitting this form, I agree to return the Mission Support Stories document* and 3-5 photos taken from the mission trip after I return home. (*Please note: The document will be emailed to you along with the confirmation of your request.)

Up to the first 300 readers and 100 sunglasses will be provided at no cost.

You will receive your handheld autorefractor 1-2 weeks before you depart for your mission trip and must send the handheld autorefractor back to National Vision the week you return. This is to ensure that National Vision is able to maximize accommodation of requests. National Vision will cover the cost to send you the handheld autorefractor. It is your responsibility to cover the cost to return the autorefractor back to National Vision.

In return for the items National Vision donates/loans to your trip, we request that you share stories, photos and data (# of patients seen, # of glasses distributed, etc.) with us upon your return.