The Children’s Medical Rehabilitation Program
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 IMPACT WITH HOPE 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 reviewed by IMPACT WITH HOPE 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.
Linda A. Greene RN, PhD
Children’s Medical Rehabilitation Program Online Application Form
Children’s LightHouse Guidelines and Rules Online Form
Parents Authorization for Treatment Online Form
Power Of Attorney Online Form
Physician’s Authorization For Treatment Online Form
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