Applications
& Forms
Guide to Sight-Saving Surgeries, Applications & Forms
Bringing Hope Through Sight- One Person, One Procedure, One Future at a Time.
Welcome to your complete guide for accessing sight-saving surgeries through Lions
Saving Sight. Whether you're seeking care or assisting someone in need, this page outlines the steps, paperwork, and contact information required to submit a successful application.
How to Apply for
Sight-Saving Surgery
To request assistance, please complete and mail your application along with all required documentation to the Intake Administrators assigned to your Lions District. All documents must be submitted in full to ensure timely review and approval.
Application Review Process
Submit All Required Paperwork to your District Intake Administrator (see contact list below). Intake Administrators will review and forward the application to the Director of Operations and Foundation Consultant.
If approved, eye examinations and surgeries will be scheduled with a high-quality eye surgeon in your area.
Required Paperwork
Checklist
- Completed Project Form
(download below)
- Financial Assessment
- Initial Eye Exam Results
- If under 65: Division of Blind Services
(DBS) or Division of Rehab Denial
- If insured: Proof of Insurance Denial
Note: Complete and accurate information will help expedite the review process.
Our Medical Leadership
MD35 Director of Operations
Judi Seltzer, MS, BSN, RN, CNOR
1315 Sterling Point Drive
Gulf Breeze, FL 32563
850-876-0005
MD35 Foundation Consultant
Norma Callanan. ND, RN
P.O. Box 1113
Deland, FL 32721
386-453-4877
Intake Administrators by District
District L
Lion Jimmie Millican
1125 W. Haves St. Suite B
Pensacola, FL 32501
850-438-8989
Lion Sue Hooten
117 Magnolia Drive
386-916-9130
District I
Norma Callahan, PDG,ND, RN
P.O. Box 1113
Deland, FL 32721
386-453-4877
Penny Gregrich PCC
4163 Watova Ave
North Port, FL 34286
941-740-2860
District O
Lion Aleta Dick
3110 Ocean Shore BIvd #211
Ormond Beach, FL 32176
724-875-9236
Vivian Henegar PDG
12449 Clubhouse Drive
Brooksville, FL 34613
252-596-8485
District N
Juan Tejera, PCC
13525 SW 23rd Street
Miami, Florida 33175
305-733-2553
Elizabeth Fisher VDG
448 Lark Avenue
Miami Springs, FL 33166
305-434-2003
Submission Tips
Double-check that all required documents are included.
Please contact your district's Intake Administrator with any questions before submitting
The more complete your application, the faster it can be reviewed and approved.