US Eye Better Together Employee Relief Fund Pledge Form
We are devastated to learn of the effects of Hurricane Ian, especially how it has impacted our US Eye employees in Southwest Florida. We hope to provide our team members with some relief during this time in the form of cash grants that they can use to for evacuation and long-term recovery expenses as they begin to rebuild.

US Eye will match all donations dollar for dollar up to $50,000 and our Founder and CEO, Dr. Shoemaker has generously agreed to personally match an additional $25,000.  

Please consider pledging any amount to help us aid our employees during this unprecedented time. There are several immediate ways to donate - including ACH, check and through a donor advised fund.  Credit card donations will be available in the coming days.  All contributions to the fund create an immediate tax deduction and will be used to support US Eye employees in need today and in the future. 
Sign in to Google to save your progress. Learn more
Your Full Name *
Your Email  *
Your Phone Number *
I pledge to donate the following amount to the US Eye Better Together Employee Relief Fund: *
Please select your Donation Method *
Do you wish to remain anonymous? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy