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Beyond Blindness 18542B Underlip Ave Santa Ana, CA 92705 Phone: 7145738888 Refer×BeyondBlindness.referral FORM PATIENT INFORMATION:Please email completed form to Refer×BeyondBlindness.outpatient
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Start by opening the 'Home - Beyond Blindness' form.
02
Read the instructions and guidelines provided on the form.
03
Begin filling out the form by entering your personal information such as your name, address, and contact details.
04
Proceed to provide details about your visual impairment, including the degree of blindness and any additional information related to your condition.
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Fill out other sections of the form such as your hobbies, interests, and any technology or aids you use to navigate your home.
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Follow any specific instructions given to provide additional documents or evidence related to your visual impairment and its impact on your living environment.
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Double-check all the information you have entered to ensure accuracy and completeness.
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Once you have filled out all the necessary sections, review the form once more and make any corrections if required.
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Submit the completed 'Home - Beyond Blindness' form as per the instructions provided.

Who needs home - beyond blindness?

01
Individuals who are visually impaired and seeking assistance for making their living environment more accessible and suitable for their needs.
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People who experience blindness or visual impairment to a certain degree and require support in adapting their home for improved functionality and safety.
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Those who want to access resources, services, or funding opportunities specifically designed for visually impaired individuals to enhance their living conditions.
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Home - beyond blindness is a program that assists individuals with visual impairment in navigating their living environment.
Individuals with visual impairment who are seeking assistance in adapting their living space.
To fill out home - beyond blindness, individuals can contact the program coordinator for an assessment of their needs.
The purpose of home - beyond blindness is to help individuals with visual impairment live independently and safely in their homes.
Information such as the individual's level of visual impairment, specific challenges in their living environment, and any assistive devices they may need.
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