To refer a client for services at World Services for the Blind, please submit the following information/documentation at least one week before the anticipated date of arrival:

1.   A completed and signed WSB Admissions Application & HIPPA Privacy Authorization Form (download below)

2.   Current medical history and medication list signed by client’s physician, and current insurance card

3.   Vision Report signed by client’s physician (dated no earlier than one year prior to admission date)

4.   Special dietary plan or listing of special medical needs

5.   Recent psychological evaluation if client has a history of psychiatric or psychological problems

6.   Copies of reports of evaluation or training activities, if applicable

7.   Authorization in the amount of $5,225.00 ($3,375.00 for training, and $1,850.00 for room & board) for 30-day evaluation

Once this information/documentation has been received, it will be reviewed by WSB staff and, upon approval, an admission date will be confirmed. If you have questions or need additional information, please contact or call 800-248-0734.

Admissions Application & HIPPA Privacy Authorization Form (Must Download PDF to Fill and Save Application)

HIPPA Privacy Authorization Form

Fee Schedule (Effective May 1, 2018)

O&M Referral Process (Word)

O&M Referral Form (Word)

What to Bring (Word) (PDF)

Client Manual (Word)