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 Director of Operations. If you are unable to submit documentation online you may call the Director of Operations using the phone number listed below and your call will be managed timely. If you are referring from the Florida Board of Health or the Division of Blind Services please contact the Director of Operations listed below.
Application Review Process
If needed, cases will be assigned to an Intake Administrator by the Director of Operations. Once all required paperwork is submitted, cases will be reviewed individually. If approved, eye examinations and surgeries will be scheduled by the Director of Operations with a qualified eye surgeon.
Required Paperwork
Checklist
- Completed Beneficiary Intake 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
Sue Hooten
117 Magnolia Drive
East Palatka, Fl. 32131
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
Aleta Dick
3110 Ocean Shore BIvd #211
Ormond Beach, FL 32176
724-875-9236
Vivian Henegar PDG
9069 Highpoint Blvd
Brooksville, FL 34613
810-444-4109
District N
Juan Tejera, PCC
13525 SW 23rd Street
Miami, Florida 33175
305-733-2553
Elizabeth Fisher DG
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.