GIHW Vision 2023-2024 Patient Registration
Thank you for expressing interest in receiving vision services with the Global Initiative for Health and Wellness and Samaritan House of San Mateo.

LOCATIONS (please check below for location indicated on specific dates):
You will receive an email with a copy of your responses to this form. This email should also contain a link where you can edit your response, if you need to change your appointment date or time. By providing us with an accurate count of patients who will be visiting us each day, you ensure that we are able to provide the needed services in a timely manner.

For more information on our clinic, please visit https://www.gihw.org/e/vision2023.

No ID nor proof of insurance is required, this program is completely free and open to the public.
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Email *
First Name *
Last Name *
Date of Birth *
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Appointment Date *
A copy of your responses will be emailed to the address you provided.
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