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ADP Form 4824-67E: Visual Aids Funding Application

Ontario's Assistive Devices Program uses this application to fund optical aids, reading and writing systems such as CCTVs and braillers, and orientation and mobility aids for people with long-term low vision or blindness. An ADP-registered authorizer assesses the patient and completes the device section. On a first application, a physician, ophthalmologist or optometrist must also sign Section 4 to confirm the vision loss.

Who completes it

The prescriber (physician or optometrist) signs the Section 4 statement that the vision loss cannot be corrected medically, surgically or with ordinary lenses, for example corrected vision of 20/70 or less in the better eye. The ADP-registered authorizer completes Section 2 and signs, the applicant completes Sections 1 and 3, and the vendor completes the vendor block.

Submitting and payment

How to submit it
The ADP-registered vendor submits the completed form to ADP electronically. Where buying from a non-registered vendor is allowed, the patient pays in full and sends the form to ADP within one year of the authorization date.
Who pays
ADP does not set or pay authorizer assessment fees and lists no prescriber fee; it pays 75% of the approved device price (up to 100% for OW, ODSP or ACSD recipients), and high-tech assessment centres may charge an administration fee that ADP funds at 75%.

Good to know

  • Low vision allows up to 3 optical aids plus one reading, one writing and one mobility aid; no functional vision allows one reading, one low-tech writing, one high-tech writing and one mobility aid.
  • Not funded: aids used for only one purpose such as school, work, sports or recreation, used equipment, items bought before authorization, and items bought outside Ontario.
  • Authorizers vary by aid: ophthalmologists or optometrists for prescription and spectacle-mounted optics, teachers of the blind, rehabilitation teachers or vision rehabilitation workers for reading aids, and high-technology authorizers for CCTVs and computers.
  • The prescriber may sign before or after the authorizer's assessment. CCTVs are lease-to-own through an ADP equipment pool, and visual aids usually come with a 30-day trial.

Get the official form

Download the current version from the source each time; forms change without notice.

Application for Funding Visual Aids

Demande de financement Aides visuelles

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Frequently asked questions

Does a physician or optometrist have to sign the ADP visual aids form?

For a first application, yes. ADP's information sheet says the patient must be examined by a physician, ophthalmologist or optometrist who completes Section 4, labelled Prescriber's Signature (if applicable). The prescriber can sign before or after the authorizer's assessment, and gives a 6-digit Ontario Health Insurance billing number.

What vision level qualifies for ADP visual aids?

The patient needs long-term low vision or blindness that cannot be corrected medically, surgically or with ordinary eyeglasses or contact lenses, for example corrected vision of 20/70 or less in the better eye, and must need the aid for six months or longer. WSIB claims and Group A veterans' pensioned conditions are excluded.

Can patients buy visual aids from a store not registered with ADP?

Only for high-technology equipment when no registered vendor is within 100 km (two quotations needed), or when buying their own computer, printer and monitor. The patient pays in full, sends the form within one year of authorization, and ADP reimburses its share after approval.