UPDATE: Due to COVID-19, the Eye Clinic is open with limited attendance of 6 patients. All patients are required to have face masks on and must follow the safety recommendations of the CDC and Dr. Bernetta Davis to receive service.
In addition to the Eye Clinic Eligibility Screening Form, patients must also sign COVID-19 Notice and Acknowledgement of Risk, Eye Clinic Appointment Questionnaire, and Eye Clinic COVID-19 Questionnaire.
- Must be an adult 18 years old or older
- Household income must be below 175% of the Federal Poverty Guidelines
- Must not have medical insurance that covers vision care
- Must be referred by any authorized government agency or non-profit organization in the D.C Metropolitan areas
For questions about eligibility and referrals, please contact Penelope Kwarikunda, our Eye Clinic Coordinator, at [email protected] or dial (301)-585-6463 X208.
Eye Clinic Eligibility Screening Form
COVID-19 Notice and Acknowledgement of Risk
Eye Clinic Appointment Questionnaire
Eye Clinic COVID-19 Questionnaire
City of Gaithersburg
Community Based Shelter
Department of Health and Human Services
Montgomery County Coalition of the Homeless Montgomery County Crisis Center
MUM (Mid County)
REAP (Assistant Program)
TESS Community Service Center UMAN (Upper County)
WUMCO (Western Upper)
- Arrive 20 minutes before your scheduled appointment
- Bring photo ID
- Check in with the Eye Clinic assistant
- Complete the forms