half Helen School Day Request
Thank you for your interest in scheduling a half Helen’s Vision Field Trip for your school! Pediatric clinics will take place on select days during the year. Please complete the form below and a member of our team will follow up with you shortly.
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School Information
School Name:
 *
School District:
 *
School Address:
 *
Main Phone Number:
 *
Primary Contact
Name: *
Title/Role at School: *
Email Address: *
Phone Number:  *
Clinic Interest
Estimated Number of Students Needing Exams:
 *
Preferred Month(s) for Clinic Day:
 *
Required
Does your school have any students with medical or accessibility needs that we should be aware of?
 *
Logistics
Our office is located at 7801 N Lamar Blvd Suite D 80 | Austin, Texas  78752
Transportation Confirmation:
 *
Required
Any additional notes or questions?
 *
Submit
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