Mobile Clinic

Mobile Clinic

Please submit your request details for an FYidoctors mobile clinic
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address (for event)

Street Address

Street Address Line 2

CityProvince

Postal Code
Why do you believe your community would benefit from our mobile clinic?
(Tell us about any barriers to eye care access, financial limitations, or other challenges.)
Are there specific concerns about vision care in your community?
(e.g., many residents haven’t had an exam in years, students struggling in school due to vision issues, lack of nearby optometry services, etc.)
Does your group require any specific accessibility requests for your community/area?
(I.e., wheelchair access, deaf, ESL support, etc.)
How many people would be interested in getting an eye exam?

Less than 1516 to 3031 to 51More than 50
Do you know of a suitable space to set up a 40-foot truck?
(e.g., parking lot, business, community center, etc.)
How did you hear about our mobile clinic?

Word of mouthSocial media (Facebook, Instagram, etc.)FYidoctors websiteNews article or media coverageEmail from FYidoctorsOther
Thank you for submitting your request for the Mobile Clinic! Due to the high volume of interest, response times may be delayed. Please note that not all requests will result in a confirmed visit. We appreciate your understanding and patience.
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