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Application and Guidelines

Click here for an English Application

Click here for a Spanish Application

To apply for medical or surgical, specialty eye care services, applicant must complete the HEA Foundation application and send with the following documents:

1.) A current county denial letter from the residing county indigent medical program is required. (Note: Patient may live in any county within Texas. Listed on the last page of the application are a few of the most requested phone numbers for local counties.) 

2.) Copy of most recent household tax return. (If household files income taxes)

3.) Copy of last two paystubs that includes year to date figures for all working individuals in the household, or a handwritten letter from employer. If self-employed, please provide a self-employment letter confirming occupation type and monthly gross income. If unemployed, a copy of any financial award letters from disability, social security or unemployment offices. If unemployed and living with family members, send proof of household income for the family and letter from family confirming they are financially supporting the applicant.

4.) If applicant has private, medical insurance, a copy of the insurance card and a copy of the insurance plan stating the deductible is required.

5.) If applicant is younger than 18 years of age, a denial from MEDICAID/CHIPS is required.

6.) If applicant is older than 65 years of age or is receiving disability, a denial letter from MEDICARE/MEDICAID is required.


To apply for Eye Care for Kids Vision Program, applicant must complete the HEA Foundation application and send with the following documents:

(**This program is only for patients 21 and under.)

1.) Copy of most recent household tax return. (If household files income taxes)

2.) Copy of last two paystubs that includes year to date figures for all working individuals in the household, or a handwritten letter from employer. If self-employed, please provide a self-employment letter confirming occupation type and monthly gross income. If unemployed, a copy of any financial award letters from disability, social security or unemployment offices. If unemployed and living with family members, send proof of household income for the family and letter from family confirming they are financially supporting the applicant.


Please Note


Upon acceptance into the HEA Foundation Program:


Houston Eye Associates Foundation is a 501 (c)3 non-profit organization committed to preserving and restoring the sight of those in need. For more information, please contact  (713) 558-8740.

7155 Old Katy Road, Suite N100, Houston, Texas 77024