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.
| eligibility_form.pdf |
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
Pompano 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
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
Pompano 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
