fbpx

GIFT OF SIGHT APPLICATION FORM

Cataracts and uncorrected refractive errors represent the primary causes of blindness globally. The Gift of Sight Trust is dedicated to alleviating this burden by offering partial funding for cataract and refractive surgeries.
Cataract occurs when the natural lens in the eye becomes cloudy and rigid. Surgery involves removing this cloudy lens and replacing it with a clear artificial lens. Refractive corneal laser surgery, on the other hand, corrects refractive errors such as myopia (short-sightedness), hyperopia (far-sightedness), and astigmatism (irregular cornea) by permanently altering the shape of the cornea. These procedures aim to restore clear vision and improve the quality of life for individuals affected by these conditions.
If you are interested in applying for  sponsorship of these procedures through the Gift of Sight Trust, please complete the following questionnaire.

Please enable JavaScript in your browser to complete this form.
Name
Marital Status
Are you currently employed?
Is your eye sight or dependence on spectacles negatively affecting your work?
Do you have any dependents?
Are you a South African citizen?
How did you hear about the GOS programme?
Have you been diagnosed with cataracts?
Are you completely blind due to cataracts?
Are you partially blind due to cataracts?
Have you had any previous eye surgery?
Is your vision affected In both eyes?
Are you on a waiting list at a Government Hospital for cataract surgery?
Do you wear glasses?
Do you wear contact lenses?
Do you have Medical Aid?
Do you have any other health/chronic conditions?
Do you use any medication?
Can you, your family or your employer make a financial contribution towards the surgery?
Can you pay for the Doctor's appointment? R1500 including tests and final diagnosis (reduced fee)
Will you be able to attend post operation follow up THE DAY AFTER THE SURGERY surgery (at no cost)
Will you be able to attend post operation follow up A WEEK AFTER THE SURGERY (at no cost)
Will you be able to attend post operation follow up SIX WEEKS AFTER THE SURGERY (at no cost)
Will you be able to buy prescribed medication to use after the surgery? (approx R 700)

DISCLAIMER

Thank you for taking the time to complete this questionnaire. You will be placed on a waiting list and will be contacted upon qualification. By completing this document, you give consent for data to be used.