CLIENT REGISTRATION FORM

If you have been diagnosed with low vision or a form of vision impairment, then CVVICS can and will assist. Please download and fill out the form below. Once completed, you can email the form to info@cvvics.org. You can also print the form and send by mail to:

CVVICS

c/o Barbara Foyil

73411 Dalea Lane

Palm Desert, CA 92260

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73411 Dalea Lane
Palm Desert, CA 92260