Los Angeles - Hometown Mission

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Hometown Mission Application Form

Information & Eligibility Guidelines

Mending Kids is a 501(c)(3) surgical nonprofit organization which provides free surgical care for underserved children around the world. For over 13 years we have mended children in over 66 countries. In 2013, we launched our first US-based surgical mission. Serving children in Southern California, our Hometown Mission program provides a chance at a better life for kids whose conditions have been deemed “non-life-threatening” or “elective” by insurance providers. We know that for a young boy with a large hairy nevus on his face, or a little girl in need of cleft-nose reconstruction, who may feel self-conscious or experience bullying as a result of their physical appearance, surgery can be truly life changing.

Please read the guidelines below to determine whether a child you know may be eligible for this program!


Which Conditions are Covered?

For the Hometown Mission, we only accept patients requiring elective outpatient, same-day surgeries. We do not accept patients that needing emergency inpatient care, organ transplants, or who have cancer or chronic conditions requiring multiple surgeries.  

Covered conditions/procedures include: 

  • Lip Palate
  • General surgeries
  • Facial Clefts
  • ENT procedures
  • Facial Tumors, Hemangiomas
  • Urology procedures
  • Plastic, Hairy Nevus
  • Orthopedic, burns reconstruction


Who is Eligible?
  • Children and young adults aged 0-21 years old 
  • Live in Southern California or be willing to arrange transportation to Southern California
  • Deductible/procedure cost is greater than 10% of total household income
  • Have been denied coverage by insurance provider or cannot afford cost of surgical care
  • Note: No proof of legal status is required to receive care through Mending Kids

Referral Information

Please fill out if you are not the parent to the child.

Patient Information


Parent/Guardian Information

Patient Medical Information

Primary care doctor, surgeon, etc.

Insurance & Income Information

I hereby certify that the information contained in this form is true and correct to the best of my knowledge and belief. I understand that submitting this form does not guarantee the provision of services.