Thank you for your interest in the Children’s Medical Rehabilitation Program. Below is an application for the Children’s Medical Rehabilitation Program. Please read the application carefully. If you have any questions, please let us know. After you have filled out the application return it to our offices.

Although ISOH/IMPACT will endeavor to locate sources of funding to assist you in providing medical treatment for your child, each applicant must be prepared to pay a non-refundable application fee of $25.00 USD, along with airfare to the United States.

Please be aware, all applications are review ISOH/IMPACT as well as medical institutions and health care professionals. All
documents must be completed and returned to our office before any final determination will be made.

Sincerely,
Linda A. Greene RN, PhD
President, ISOH/IMPACT

Children's Medical Rehabilitation Program online application form
Children's LighHouse Guidelines and Rules form
Guardianship Consent Form (.doc)
Power of Attorney Form (.doc)
Physician's Authorization for Treatment Form (.doc)

Children's Medical Rehabilitation Program Form, in Russian (.doc)
Guardianship Consent Form, in Russian (.doc)
Power of Attorney Form, in Russian (pdf)
Physician's Authorization for Treatment Form, in Russian (.doc)

Please note: All applications must be submitted in English plus language of origin.