Vision Services Application

The Lighthouse's vision services include eye exams, eyeglasses, and eye surgeries. If you need glasses or an eye exam, please complete the application below. If you feel you need an eye surgery, please complete the surgery application. Thank you!

Please note, you must upload every piece of documentation listed below in order to submit your application online. If you cannot scan your documents, or you do not have all of the necessary documentation at this time, please mail your application to:

Georgia Lions Lighthouse Foundation
Vision Services
1775 Clairmont Rd.
Decatur, GA 30033

Step 1: Attach the Application

Step 2: Please provide proof of identification using a copy of one of the following:

GA Driver's License
State of GA Identification Card
GA birth certificate
Voter's Registration Card

Attach Proof of Identification

Step 3: Please provide proof of Georgia residency through one of the following:

Lease contract (if renting)
Mortgage Statement if you own your home
Referral from shelter or transitional home, or
Referral from nursing home.

Attach Proof of GA Residency

Step 4: Proof of income
Household income must include all persons residing at the applicant's address. Please provide a copy of the following information for everyone living at the applicant's address. Please scan all documents and save them as one file before uploading them.

Last year's tax return AND any of the following that apply:

Three current pay check stubs
Social Security Administration Award Letter
Food Stamp Papers from Family and Children Services (award summary notification)
Unemployment claim, if unemployed - wage inquiry statement from the GA Dept. of Labor
Information indicating the applicant is receiving TANF, Social Security Disability, Pensino, Retirement, Veterans Administration Benefits, or any other sources of income.
Last three months of bank statements and/or
Letter from nursing home stating income benefits.

Proof of Income

Step 5: Copy of your current prescription
Medicaid and Medicare usually cover an annual eye exam. Your prescription needs to be less than one year old and signed by a doctor. If you do not have Medicaid or Medicare, or your eye exam is not covered, you do not need to upload a prescription at this time.

Attach Your Prescription

Better Vision. Better Hearing. Better Georgia.