Form – Optometrist
Your patient, , has applied for financial assistance through COVTR’s Betty Fretz Scholarship Fund for your recommended in-office Vision Therapy Program.
The Betty Fretz Scholarship Fund was created in 2018 by COVT&R as a means to offer financial aid to those patients who would otherwise not be in a position to receive the care they require through in-office Vision Therapy.
Before your patient’s application can be processed, we need some information from you!
- The person named above is my patient or is the parent/guardian of my patient.
- I have recommended in-office Vision Therapy as the best treatment option for the above named patient.
- I have reasonable belief that the above named patient is in need of financial assistance and may otherwise not be in a position to receive Vision Therapy as a treatment avenue.