The Aberdeen Lions are always willing to help those in need.  However, being a smaller organization, we reserve our limited funds to those who cannot ascertain assistance from agencies that are more capable of absorbing the associated costs.  We will review your request and contact you shortly after our next scheduled meeting.  If you have any questions, please contact the organization which provided this form to you.

Download form to print and mail in:  Lions Club Request for Eye Exam / Eye Wear Assistance


Name *
Name
Address *
Address
Phone *
Phone
If no, please contact them at 947-2436 before completing this form.
If you are eligible for Medicaid, we will be glad to find a provider who accepts this insurance to provide care for you.
If you are eligible for Medicaid, we will be glad to find a provider who accepts this insurance to provide care for you.
They are available at the Medicaid office two days per week (Tuesday & Friday). Please call (910) 947-7497 to find out which day they have available appointments and apply with them.
$
$
$
Signature *
Signature
Date *
Date