Free Information

Your free information will arrive in the mail in about five to seven business days. Inside your free information packet will be a price guide, order form, product brochures, and an eye chart. The eye chart will help us learn more about your vision and determine which system can give you the most help. A low vision consultant will help you use the eye chart and explain the level of benefit you can expect from the VideoEye system. Thank You for your interest in our product.

Yes, please send me information about the VideoEye! I understand that there is no cost for this information, and that I am under no obligation.
I am requesting Information for:		Myself Spouse Mother Father Relative Friend Other
Please send to:		Myself Spouse Mother Father Relative Friend Other
The person receiving this information:		has low vision does not have low vision
Title:		None Mr. Mrs. Miss Ms. Dr.
Name:		*
Street Address		*
Street Address
City, State Zip		*
Country
Phone Number:		International prefix *
Email Address		*
If you are ordering a brochure for someone else please provide us with your name and email address.
Name
Phone Number		International prefix
Email Address
Visual Ability of person with low vision		Still Driving Can read small newspaper print with magnification Can read a newspaper headline with magnification Cannot read with magnification Unknown
Where did you learn about the VideoEye!		*
Comments / Questions
* Required

For further comments/questions contact us at info@videoeyecorp.com