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.
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