SERVICES

The Georgia Lions Lighthouse Foundation connects Georgians in need
with vision and hearing services.

SERVICE APPLICATION

The Georgia Lions Lighthouse Foundation connects patients to complete eye exams and, when needed, prescription eyeglasses. Clinics are held regularly at the L.B. Buddy and Peggy Patrick Harrell Jr. Vision Clinic in Chamblee, Georgia, and via mobile clinics throughout the state on a rolling basis.

Our mission is to serve Georgians who need us most. Please review the requirements and supporting documents below, and if you qualify, patients can apply for services either online or by printing, completing, and mailing an application.

IDENTIFICATION

IDENTIFICATION (PROVIDE ONE)
Valid driver’s license, State photo ID, Valid passport, Valid school picture ID, Consulate card, Permanent Resident Alien card or Birth Certificate

PROOF OF RESIDENCY

PROOF OF RESIDENCY
Current copy of lease agreement, current copy of mortgage statement, utility bill from the last 3 months, letter from a shelter or residence facility, or letter form nursing home.

PROOF OF GROSS INCOME

PROOF OF GROSS INCOME
Last 3 months of bank statements, Last year’s tax return, Social Security/Disability award letter, 4506-T Form (non-filing), proof of College or University scholarship, grant, fellowship, or assistantship, 2 current consecutive paycheck stubs, or proof of regular payments of alimony, child support, unemployment, union funds, retirement or other government program.

Understand?

I Understand Qualifications

Download Print Version of application

The Georgia Lions Lighthouse Foundation works with a network of ophthalmologists to provide patients with optical surgery when needed.

We provide surgery assistance for:

Cataracts
Glaucoma
Diabetes-related vision loss

Our mission is to serve Georgians who need us most. Please review the requirements and supporting documentation below and if you qualify, patients can apply for services either online or by printing, completing, and mailing an application.

Requirements for Services include:

Resident of Georgia for at least one year
Do not have insurance or other way to pay for surgery
Meet the financial guidelines

IDENTIFICATION

IDENTIFICATION (PROVIDE ONE)
Valid driver’s license, State photo ID, Valid passport, Valid school picture ID, Consulate card, or Permanent Resident Alien card

PROOF OF RESIDENCY

PROOF OF RESIDENCY (PROVIDE ONE)
A Current copy of lease agreement, a current copy of mortgage statement, a utility bill from the last 3 months, a letter from a shelter or residence facility, or letter from nursing home.

PROOF OF GROSS INCOME

PROOF OF GROSS INCOME (PROVIDE TWO)
Last 3 months of bank statements, Last year’s tax return, Social Security/Disability award letter, 4506-T Form (non-filing), proof of College or University scholarship, grant, fellowship, or assistantship, 2 current consecutive paycheck stubs, or proof of regular payments of alimony, child support, unemployment, union funds, retirement or other government program

ADDITIONAL DOCUMENTS

ADDITIONAL DOCUMENTS (PROVIDE ALL)
An eye doctor’s most recent exam notes indicating need for surgery and documentation from within the last 3 months verifying current Medicaid/Medicare denial

Understand?

I Understand Qualifications
I have printed and/or made physical copies of ALL required documentation for each member of my household. I understand that my application will NOT be processed until all required documents have been submitted.

The Georgia Lions Lighthouse Foundation Pediatric Hearing Program offers high-quality, affordable hearing services to Georgia families who are uninsured or underinsured and fall between the gaps in Medicaid, PeachCare, and the federal limit for families receiving subsidies or tax credits. Program Benefits include:

Up to 2 digital hearing aids from top manufacturers
9 audiologist appointments (over 3 years)
3-year repair warranty and 3-year loss and damage warranty
Up to 12 earmolds for bilateral loss

Requirements for Services include:

Age – Birth to 19 years
Hearing test performed by Lighthouse provider
Resident of Georgia for at least one year
Family income below 400% of poverty guidelines
Uninsured or insurance denial of coverage for hearing aids
Birth Certificate or valid Georgia ID

Haven’t seen an audiologist yet? Click here to see the list of Georgia Lions Lighthouse Foundation approved providers.

Photo ID

PHOTO ID (PROVIDE ONE)
Valid Driver’s License, State Photo ID, Valid Passport, Valid School Picture ID, Consulate ID Card, or Birth Certificate

Proof of Residency

PROOF OF RESIDENCY
Current copy of lease agreement, Current copy of mortgage statement, Utility bill (current within 3 months), Letter from shelter signed by a shelter employee, or a Letter from nursing home

Proof of Income

PROOF OF INCOME
2 current consecutive paycheck stubs for bi-weekly pay; or 4 current consecutive paychecks, stubs for weekly pay, Last 3 months of bank statements will only be accepted for SSA or SSI, Official tax transcript/Tax Returns 201social Security/Disability award letter, Non-filing letter from IRS, College/university scholarship, grant, fellowship, or assistantship Regular payments from alimony, child support, unemployment, union funds, retirement, or other government programs proof of Income

Insurance Statement

INSURANCE STATEMENT
Copy of your insurance statement of coverage, ONLY IF you have insurance that covers hearing aids AND is a high-deductible plan

Hearing Test

HEARING TEST
Copy of current (<3 months old) hearing test

Understand?

Download Print Version of application

The Georgia Lions Lighthouse Foundation Hearing Aid Program provides low-cost hearing aids to qualifying Georgia residents. Patients, who are seen by a network of over 160 partner hearing providers throughout the state, receive brand new digital hearing aids. Requirements for Services include:

Current hearing test (less than 6 mo. old)
Income within 200% of federal poverty guidelines
Resident of Georgia for at least one year
Valid Georgia identification card

Haven’t seen an audiologist yet? Click here to see the list of Georgia Lions Lighthouse Foundation approved providers.

Photo ID

COMPLETED RECOMMENDATION & WAIVER FORM
Completed provider recommendation and medical clearance/waiver (COMPLETE AND PRINT PRIOR TO APPLYING)

Photo ID

PHOTO ID (PROVIDE ONE)
Valid Driver’s License, State Photo ID, Valid Passport, Valid School Picture ID, Consulate ID Card, or Birth Certificate

Proof of Residency

Proof of Income

Insurance Statement

INSURANCE STATEMENT
Copy of your insurance statement of coverage, ONLY IF you have insurance that covers hearing aids AND is a high-deductible plan

Hearing Test

HEARING TEST
Copy of current (<6 months old) hearing test

Understand?

Download Print Version of application

ONLINE PAYMENT SERVICES

The Georgia Lions Lighthouse Foundation believes all patients should have access to vision and hearing care. As a result, fees are established based on the patient’s economic status.

We are currently experiencing phone system issues: CONTACT US

SERVICES

The Georgia Lions Lighthouse Foundation connects Georgians in need
with vision and hearing services.

SERVICE APPLICATION

ONLINE PAYMENT SERVICES

WANT TO GET INVOLVED?

ABOUT US

SERVICES

WAYS TO GIVE

We are currently experiencing phone system issues: CONTACT US

SERVICES

The Georgia Lions Lighthouse Foundation connects Georgians in need with vision and hearing services.

SERVICE APPLICATION

ONLINE PAYMENT SERVICES

WANT TO GET INVOLVED?

ABOUT US

SERVICES

WAYS TO GIVE

The Georgia Lions Lighthouse Foundation connects Georgians in need
with vision and hearing services.