Service Forms

Before receiving services from GDABVI, you'll need to complete forms that give us permission to discuss your needs, share information among staff who'll be working with you, give us background on your vision situation, and request information from your eye care professional.

After you've completed and submitted your forms, you'll then be contacted for next steps. You can also call our office to speak with our Community Health Worker at 313-591-3793 to request that someone assist you in completing the forms by phone.

STEP 1

Click here to complete our online intake form. This form collects information about the person we'll be assisting and what they need help with. This form also allows you to provide your consent for the use and release of your personal information in order to provide services. 

 

Consent forms are good for three years from the date signed unless you notify us in writing that you are revoking your consent.

STEP 2

Click here to download a copy of our Vision Exam Form. This document needs to be completed by the client's vision care professional. 

We look forward to working with you!