Patient Application

The Vision Project's 2019 surgical dates are February 16th and March 2nd. Below you will find our Vision Project Referral Form and Patient Application. If you have any questions at all, please reach out to a member of our Vision Project Committee by calling 952-346-2192 or emailing

The Vision Project Referral Form
For physicians looking to refer a patient to The Vision Project surgical program, please complete this form and fax back to us at 952-567-6156, Attn: The Vision Project. You may also email this form to us at

Download the Referral Form

The Vision Project Patient Application
For patients wanting to apply for The Vision Project surgical program, please complete the Patient Application to the best of your ability. If any questions are left blank or filled out vaguely, it will delay the qualification process, so it's very important that this document is filled out thoroughly. For questions, please feel free to email us at 

**To fill out the Spanish version of the application, please complete The Vision Project Patient Application (Spanish) and fax it to 952-567-6156 or email it to

Apply for the Charity Outreach Program