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HEA Foundation Office

Application and Guidelines

Click here for an English Application

Click here for a Spanish Application

To apply for medical or surgical 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 or its surrounding states.  Listed below are a few of the most requested phone numbers for local counties.

2.) Copy of household 2015 1040 filed tax return. If tax return is unavailable, send proof of income, such as a W-2 or a handwritten letter from employer or supporting family/friend confirming applicant's income. If unemployed or living with family members or friends, proof of household income for the family.

3.) Copy of the last two paystubs that include year to date figures for all working individuals in the household or a copy of any financial award letters from disability, social security, or unemployment office. If paystub or award letter is unavailable or if applicant is being supported by another individual, please complete the Financial Support Document.

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.

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 Jessica Tegethoff at or (713) 558-8740.

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