Thank you for your interest in Junior Blind's teen and adult services! Please complete the form below and our program directors will be in touch.
Please note: This form asks for Protected Health Information (PHI) and is stored on a secure server. Access to this information is granted only to Junior Blind staff who have a need to access the information to complete the request that has been made. For more information on Junior Blind’s privacy practices, please view our Notice of Privacy Practices.