Light of the World Clinic is a free health care clinic.
Do you need to see a doctor or get a general check-up, but are uninsured and unable to pay for medical care?
The clinic with its 300+ volunteers and 50+ licensed providers donate over 7,500 service hours to help and treat the clinic’s qualified patients.
The clinic is NOT a walk-in clinic and requires prior qualification before any appointments can be given. Sorry, but no exceptions!
To begin the qualification process, please stop by the clinic and pick up an application packet, or you can follow the instructions listed below and submit your application by mail or the online form below:
MAIL IN APPLICATIONS:
1) Download the application packet by clicking the button below.
2) Completely fill in and sign pages 3, 4 & 5 of the application packet – do not leave any spaces blank as this may delay the approval process. If something does not apply to you, simply mark N/A or indicate that this does not apply to you.
3) Attach a copy of the necessary documents as indicated on page 2 of the application packet.
4) Once you have completed the form, mail OR drop off your completed applications along with the proper documentation to the address below. Please note that all applications require your original signature and therefore, NO Faxed or Emailed Applications can be accepted.
NOTE: Please keep in mind that incomplete applications and incomplete documentation submittals will delay the approval and processing of your application.
Once we have received your completed application either by mail, online or in person, it takes approximately 3-7 days for a response.
We look forward to assisting you in the near future!
Patient Eligibility Coordinator:
Light of the World Clinic, Inc. 5333 N. Dixie Hwy #201, Oakland Park, FL 33334
Office: (954) 563-9876 ext. 206
Before filling in the application below please download and read the application document requirements. You application will not be complete if we do not receive the necessary documents.
ONLINE APPLICATIONS:
1) Completely fill in and sign the form below – do not leave any spaces blank as this may delay the approval process. If something does not apply to you, simply mark N/A or indicate that this does not apply to you.
2) All applications require your original signature and therefore, NO Faxed or scanned applications can be accepted.
NOTE: Please keep in mind that incomplete applications and incomplete documentation submittals will delay the approval and processing of your application.
PLEASE READ THE DOCUMENT REQUIREMENT LIST BELOW PRIOR TO FILLING IN YOUR ONLINE APPLICATION:
REQUIRED DOCUMENTS LIST - CLICK TO OPEN
Applicants must provide the following documents with their application for consideration and final approval.
1. COPIES of 2 forms of photo identification– ONE with your current address for each person applying
– a. COPY of Birth Certificate and School ID foreach minor child under 21 living at home
2. Proof of domicile requirements: Please supply ONE of the following documents.
– a. COPY of current lease agreement/contract along with a copy of the last rent payment receipt. OR
– b. COPY of last paid mortgage statement. OR
– c. If you don’t have a rental agreement or own a home – then you MUST submit a “RentVerification Form” or an ORIGINAL notarized letter from Landlord with details of your current living arrangement:
•Monthly rental amount
•Complete address with city and zip code
•Are utilities included?
•Length or terms of living arrangement(monthly, yearly)
3. Proof of Income requirements: Please supply any of the following documents that apply to your family situation.
– a. COPIES of the last 6 weeks consecutive pay stubs for ALL adults in the family.
– b. If your employer pays you in cash you MUST submit an ORIGINAL notarized letter verifying employment.
– c. If you are self-employed, you MUST submit anORIGINAL notarized letter stating youroccupation and monthly income.
– d. If you don’t work, you MUST still submit anORIGINAL notarized letter stating that you have no income and explain why.
4. COPY of your CURRENT BILLS: FPL, Phone or otherUtility Bill you have in your name.
5. COPY of your most recent tax return (ALL PAGES)including W2/1099 if you filed one.
6. COPY of ALL car registrations for the household in your name.
LISTA DE DOCUMENTOS REQUERIDOS - HAGA CLIC PARA ABRIR
Aplicantes deben presentar los siguientes requisitos, los cuales serán revisados por la clı́nica para aprobación final.
1. COPIAS de 2 formas de identificación – UNA con ladirección corriente para cada persona que estaaplicando.
– a. COPIA del Acto de Nacimiento e Identificaciónde la Escuela/Universidad para cada menor de21 años de edad, que vive en el hogar
2. Prueba de vivienda o domicilio: Presente UNO de los siguientes documentos.
– a. COPIA del contrato de alquiler con copia del último recibo de pago de renta.
– b. COPIA de la hipoteca y copia del último recibo de pago de hipoteca/”mortgage”.
– c. Si no tiene contrato de alquiler o propiedad -puede someter una “Verificacion de Renta” o una carta notariada (ORIGINAL) por el dueño del hogar describiendo los detalles de la vivienda. La carta tiene que incluir:
•Cuánto pagan mensual de renta?
•La dirección completa
•Incluye luz, agua, cable, internet?
•Fecha cuando se termina el contrato.
3. Prueba de ingreso: Presente cualquier documento siguiente que le aplique a usted y su pareja para cumplir con este requisito.
– a. COPIA de los últimos desprendibles del cheque de pago de las últimas 6 semanas para todos los adultos en el hogar.
– b. Si le pagan en efectivo o trabaja por sí mismo, necesita una carta notariada (ORIGINAL) verificando empleo y detallando su tipo de trabajo e ingreso mensual.
– c. Si usted o su pareja no trabajan, necesitan una carta notariada (ORIGINAL) donde declaran que no trabajan y que no tienen ingreso.
4. COPIAS de CUENTAS MAS RECIENTE: Luz, Agua, Telefono o otra cuenta en su nombre.
5. COPIA de la Declaración de impuestos más reciente si han declarado con W2/1099(TODAS LAS PAGINAS).
6. COPIA de la registración de TODOS los vehículos en el hogar que están en su nombre.