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EyeCare America® Ambassador Request Form

Thank you for helping to spread the word about EyeCare America and eye health. We are happy to provide complimentary digital materials.
Questions? Email eyecareamerica@aao.org.
1. Are you a current EyeCare America Ambassador? *This question is required.
2. How have you used the materials to date? (check all that apply) *This question is required.
2. Have a picture of our materials in use? We would love to see it. 
2. How did you hear about EyeCare America? *This question is required.
2. Digital Materials 

Digital materials include banner advertisements, PowerPoint Presentations and information to include in your newsletters or on your website.

Are you interested in received these digital materials?
3. Eye Health Digital Materials

Digital materials on eye health topics are available in both English and Spanish for download. Topics include Age-Related Macular Degeneration, Cataract, Glaucoma and many other topics. 

Are you interested in receiving digital materials on Eye Health topics?
4. EyeCare America Program Digital Materials

Digital materials include information about the EyeCare America Program. It includes brochures, flyers and a digital drug discount card

Are you interested in receiving digital materials about the EyeCare America Program? 
6. Contact Information 

Kindly provide your contact information. The materials will be emailed and/or mailed to the address provided:
This question requires a valid email address.
7. Type of Organization *This question is required.
8. EyeCare America Communication

EyeCare America's periodically sends emails containing eye health and program information that will help in providing information to your clients, patients or to the public.

Would you like to periodically received emails from EyeCare America?  
  • This question is required
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