Request a Blue Envelope or Deaf Visor Card

Using this form, you may request a Blue Envelope or a Deaf Visor Card.

The Blue Envelope and the Deaf Visor Card are free and easy to use. You do not need to produce medical records or register for either.

No one will know you are requesting or using either unless you tell them.

Please send me

Blue Envelope (VE-136)

Deaf Visor Card (VG-100)

Number of Envelopes (VE-136) Requested

Maximum of 5 per request.

Number of Visor Cards (VG-100) Requested

Maximum of 5 per request.

First

Middle

Last

Address

City/Town

State/Province

ZIP/Postal Code

Country

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