Rehabilitation Services for the Blind Referral

Rehabilitation Services for the Blind (RSB) offers services to help blind or visually impaired persons reach personal and employment success. If you, or someone you know, would like to talk to a team member about our services, please complete the form below. The information you provide will be sent to our team for review and we will be in contact as soon as possible to discuss services. 


Information for person you are referring

When entering SSN enter numbers only i.e.; 999999999

When entering phone number enter numbers only i.e.; 9999999999

Is the individual employed? (required)

Would the individual like a job?

The individual is interested in the below services (check all that apply)    (required)

Name, phone number and relationship of individual completing referral page

How did you hear about RSB? (select one)    (required)

If you would like to attach any supporting documentation such as the individual’s eye exams, individualized education plan, Social Security award letters, etc. to help us determine eligibility, please attach them here.






    Thank You

    This message confirms that you have submitted a Rehabilitation Services for the Blind (RSB) referral.

    Your referral ID is {formuniqueid}.

    Please keep this number in case you need it. A member of our team will be in contact with the referred person as soon as possible. If you need help now, you can call us at 1-800-592-6004 or send us an email at

    Thank you,

    Missouri Department of Social Services

    Rehabilitation Services for the Blind