Light Ones Path Foundation
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Free Clinic
​Patient Eligibility Form

Patient Eligibility Information & Application Form

The clinic is NOT a walk-in clinic and requires prior qualification before any appointments. ​Patients with ANY INSURANCE are not eligible.
​
​Please download the application form below and follow the instructions.

2020eligibility_clinic_form.pdf
File Size: 6400 kb
File Type: pdf
Download File

To begin the qualification process, please stop by the corporate office to pick up an application form or follow the steps below:
1) Download the 1 page application form above.
​2) Completely fill and sign the application form.  If something does not apply to you, simply mark  N/A or indicate that this does not apply to you.
3) Once completed, mail OR drop off your completed applications to the following address:

Light Ones Path Foundation, INC.
Attn: Eligibility Coordinator 
601 E Sample Road ,  Suite #101
Deerfield Beach, FL 33064


NOTE:  Please keep in mind that incomplete application will delay the approval and processing of your application.
Once we have received your completed application, it takes approximately 5-7 days for a response.

​Please take a look on the federal poverty level chart below to validate the eligibility criteria
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Telephone: 954-461-7941    ||     Email: lightonespath@gmail.com
  • Home
  • Our Mission
  • Our Inspiration
    • Rahul's Story
    • Stories About Rahul
  • Free Clinic
    • Hours / Directions
    • Patient Eligibility Form
    • Volunteer Application
  • 5th Annual 5K Run/Walk
    • Register Now!
    • Sponsor / Donate
    • Our Supporters
  • About Us
    • Executive Committee
    • Contact Us
    • Volunteer Opportunities!
    • Donate!