2025 ACVO/Epicur Service Animal Volunteer Eye Screening Registration

2025 ACVO/Epicur Service Animal Volunteer Eye Screening Registration

Thank you to all the ophthalmologists and clinics that donated time and services through participation in the ACVO/Epicur Service Animal Volunteer Eye Screening. We hope that you will choose to participate again. Please complete this form as early as possible to increase your clinic’s chances of being covered by local media and help local owners plan for the event.

This official ACVO Member registration form will be open February 7th through March 6th. In order for the 2025 event to move forward, at least 200+ ACVO Members will need to sign up before the member registration closing deadline of March 6th. Please encourage your colleagues to register as soon as possible!

Event Note: When appointments are full, you may choose to contact the ACVO and we can update the contact list for participants online, if you wish.

Remember to check this page for promotional resources for your clinic. They will be fully updated early around mid-March!

Notes:
Have you participated in the ACVO®/Epicur Service Animal Volunteer Eye Screening in the past?

Have you participated in the ACVO®/Epicur Service Animal Volunteer Eye Screening in the past? Yes No
If you answered yes, do you have any photos we could use to promote the event (with name of the animal and have permission from the client that we would be able to use)?

If you answered yes, do you have any photos we could use to promote the event (with name of the animal and have permission from the client that we would be able to use)? Yes No
Upload Photo(s) Here (Max file size 2MB):

Attach Files
Description for photo(s) uploaded above:
If you answered yes, do you have a Service Animal success story you could share with us for marketing and PR purposes? (For example, a success story could be: how a free eye exam provided to your patient through the ACVO event caught a disease in an early stage and allowed you to treat it before it could negatively impact the Service Animal and its owner; a story about a Service Animal owner who has been attending this eye exam event every year for the past 10 years and relies on the annual program; etc.) If you mark ‘Yes’ we will have our PR firm reach out to you for a convenient time to discuss.

If you answered yes, do you have a Service Animal success story you could share with us for marketing and PR purposes? (For example, a success story could be: how a free eye exam provided to your patient through the ACVO event caught a disease in an early stage and allowed you to treat it before it could negatively impact the Service Animal and its owner; a story about a Service Animal owner who has been attending this eye exam event every year for the past 10 years and relies on the annual program; etc.) If you mark ‘Yes’ we will have our PR firm reach out to you for a convenient time to discuss. Yes No
Is your clinic open to possibly accepting an on-site media interview opportunity (print, TV) that would include a Diplomate, a service animal, and its owner or handler?

Is your clinic open to possibly accepting an on-site media interview opportunity (print, TV) that would include a Diplomate, a service animal, and its owner or handler? Yes No
If you answered yes, do you have 1 or 2 specific patients (could be a patient from the success story noted above) in mind who have participated in this program at your clinic successfully during a previous year? If you are open to considering on-site media interviews during an eye exam, could you select a day(s)/time(s) in May for us to invite your local media to the clinic for interviews/filming? (This is very helpful when handling calls from the press, to let them know specific availability for scheduling if possible.)
Are there any Service/Working Animal groups you work with you would like our office to send an invitation to for the event? Please list group name and email address below.
Information Provided to Participants for Appointments
(Note: All desired contact data must be provided in this form.)
LOCATION #1
Clinic Name
Phone (for appointments)
Do you prefer appointments be made by email? If yes, please enter the email address you wish the public to use below.
Website
Physical Address Physical Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Participating Active ACVO Member Name(s)
Equine Exams Available? (This will be made available on a private list only sent to those who request an ophthalmologists willing to do equine eye exams as a part of this program).

Equine Exams Available? (This will be made available on a private list only sent to those who request an ophthalmologists willing to do equine eye exams as a part of this program). Yes No
A second location?

A second location? Yes No
LOCATION #2
Clinic Name
#2 Phone (for appointments)
Do you prefer appointments be made by email? If yes, please enter the email address you wish the public to use below.
#2 Website
#2 Physical Address #2 Physical Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
#2 Participating Active ACVO Member Name(s)
A third location?

A third location? Yes No
LOCATION #3
Clinic Name
#3 Phone (for appointments)
Do you prefer appointments be made by email? If yes, please enter the email address you wish the public to use below.
#3 Website
#3 Physical Address #3 Physical Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
#3 Participating Active ACVO Member Name(s)
Administrative Contact Information

This information is for internal use and will not be provided to participants. Please provide contact information for the key person responsible for organizing and promoting your event.

Admin emails are helpful for asking questions about a clinic, receiving important notices and helpful promotional items, etc.
Administrative Contact Name
Admin Email
Additional Information
Web Site
Type the letters you see in the image below.