Online Pre-Application

Begin Our Eligibility Quiz for Services

PLEASE READ BEFORE YOU INQUIRE

Before you inquire about LVS services, please note that we only serve South Carolina residents. If you have not lived in South Carolina for at least 1 year, please do not inquire about our services.

Due to the high volume of inquires we receive, we cannot respond to out-of-state requests.

First Name

Last Name

Email Address

Phone Number

Mailing Address

City

State

Zip Code

Please indicate for which services you are requesting assistance (check all that apply). Please indicate for which services you are requesting assistance (check all that apply). Eye Surgeries Eyeglasses Vision Technology

Do you have health insurance?

Have you had an eye exam by an ophthalmologist?

Name of Facility

Name of Physician

Online Pre-Application

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