Welcome to the Lighthouse Vision Surgery Application!

PLEASE READ CAREFULLY

ALL applicants are required to provide an email address. You may use a social worker or other organizational representative’s email address with their permission, but you are responsible for following up with them on any emails received regarding your application.

We recommend you create your own email address. GmailOutlook, and Yahoo! Mail are all free and commonly used email services.

CLICK HERE TO VIEW THE APPLICATION INFO PACKET.

IMPORTANT: Please be prepared to upload ALL of these items:

– Proof of income (ex: check stubs, Disability award letter, etc.) for ALL MEMBERS OF YOUR HOUSEHOLD
– Proof of identification (ex: valid driver’s license, consulate ID card, etc.)
– Proof of Georgia residency (ex: utility bill, lease agreement, etc.)
— Your eye doctor’s notes indicating that you need eye surgery
— Medicaid/Medicare denial letter dated within the past three (3) months

You CAN use your phone to take a photo of these items! Please ensure that ALL files are clearly legible and that the entire document can be seen.

If you are prepared to complete the Lighthouse vision services application at this time, please check the box below to continue.

Vision Surgery Pre-Application Form
Please read below and check the box to continue. *
Please read below and check the box to continue. *