Become A Patient

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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?

You might qualify for the comprehensive services offered by the Light of the World Clinic and its talented volunteer staff. Click here to see our services

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:

HOW TO BECOME A PATIENT OF THE CLINIC

STEPS TO APPLY:

  1. Fill out the Application Form completely.
  2. Bring or mail the form with ALL required attachments/ documents to the clinic.
  3. Include a non-refundable $25 application fee by money order or cash.
    • One fee per family application per year.

After we review your application, if you qualify, we will call you to schedule an eligibility appointment.

NOTE:  Please keep in mind that incomplete applications and incomplete documentation submittals will delay the approval and processing of your application.

COMO APLICAR PARA SER PACIENTE DE LA CLINICA

PASOS PARA APLICAR

  1. Complete el Formulario de Solicitud en su totalidad.
  2. Traiga a la clínica o envíe por correo la aplicación junto con TODOS los requisitos solicitados.
  3. Incluya el pago no-reembolsable de $25 en efectivo ó money order. (billetes de $20 ó menos)
    • Una sola cuota por solicitud familiar por año.

Después de revisar su solicitud, si califica, le llamaremos para programar una cita en nuestra oficina.

DOWNLOAD THE PATIENT APPLICATION FORM

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.

DOWNLOAD DOCUMENT REQUIREMENT LIST

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:

WHAT YOU WILL NEED

Applicants must provide the following documents with their application for consideration and final approval.

  1. COPIES of 2 forms of photo identification for each person applying. ONE with your current address.
    For children under 21: COPY of Birth Certificate and School ID for each minor child living at home.
  2. Proof of domicile requirements:
    Please supply ONE of the following documents:

    • COPY of current lease agreement/contract along with a copy of the last rent payment receipt. OR
    • COPY of last paid mortgage statement. OR
    • If you don’t have a rental agreement or own a home — then you MUST submit a “Rent Verification 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 the document that best reflects your current situation and that of your spouse/partner.
    Options:

    • If you work for a company: COPIES of paystubs for the last 6 consecutive weeks for ALL adults in the family.
    • If your employer pays you in cash or you are self-employed: you MUST submit an ORIGINAL notarized letter stating your occupation, indicate how you get paid and how much you earn (weekly or monthly).
    • If you don’t work, you MUST still submit an ORIGINAL notarized letter stating that you have no income and explain why.
  4. CURRENT BILLS: COPY of two bills from most recent month — FPL, phone, water, internet or other bill you have in your name.
  5. Most recent tax return: COPY of ALL PAGES including W2/1099 if you filed one.

LO QUE NECESITARÁS

Aplicantes deben presentar los siguientes requisitos, los cuales serán revisados por la clínica para aprobación final.

  1. COPIAS de 2 formas de identificación de cada persona que aplica. UNA con foto y, de ser posible, con dirección actual para cada persona que está aplicando.

    Para los hijos menores de 21 años: COPIA del Acta de Nacimiento e Identificación de la Escuela/Universidad para cada hijo que vive en el hogar.
  2. Prueba de vivienda o domicilio:
    Presentar UNA de las siguientes opciones:

    • COPIA del contrato de alquiler con copia del último recibo de pago de renta ó
    • COPIA de la hipoteca y copia del último pago de hipoteca/”mortgage” ó
    • Si no tiene contrato de alquiler o propiedad — puede entregar una carta notariada (ORIGINAL) por el dueño del hogar describiendo los detalles de la vivienda. La carta debe incluir:
      • Cuánto pagan mensualmente de renta
      • La dirección completa
      • Si incluye luz, agua, cable, internet
      • Fecha cuando se termina el contrato
  3. Prueba de ingreso: Presente el documento que refleje su situación de ingresos y la de su pareja.

    Opciones:

    • Si trabaja en una empresa: COPIA de los últimos desprendibles del cheque de pago de las últimas 6 semanas para todos los adultos en el hogar.
    • Si le pagan en efectivo o trabaja por cuenta propia: carta notariada (ORIGINAL) verificando empleo y detallando su tipo de trabajo e ingreso mensual.
    • Si usted o su pareja no trabajan, necesitan una carta notariada (ORIGINAL) donde declaran que no trabajan y que no tienen ingreso.
  4. FACTURAS MÁS RECIENTES: COPIAS de dos facturas: Luz, agua, Teléfono, cable u otra cuenta a su nombre.
  5. Declaración de impuestos: COPIA de la declaración más reciente si han declarado con W2/1099 (TODAS LAS PÁGINAS).
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