Application Form

Either fill out the form below and click submit or download and post the PDF Here

Disclaimer:

The Monitoring Systems are provided by Epilepsy Lifestyle to assist the User in their management or the management of the Patient and to help minimise risk. No warranty is given by Epilepsy Lifestyle as to the accuracy of the Monitoring

Systems and Epilepsy Lifestyle accept no liability for any consequences of reliance on the Monitoring Systems or of any actions taken by the Patient or any medical practitioner in reliance on the Monitoring Systems. The Monitoring Systems should not be used as a replacement for observation of clinical signs.

Guidelines for applications

  1. This is a rolling programme so applications can be made at any time.
  2. We accept applications for any diagnosed patients of any age.
  3. Your application will be acknowledged when it is received and we will respond to you with a decision as soon as possible.
  4. Beneficiaries can only apply for one type of monitoring system.
  5. Wherever possible Epilepsy Lifestyle will order the monitoring system direct from the supplier and arrange delivery to your home.
  6. A letter showing proof of epilepsy diagnosis must be submitted to accompany the application. This can be emailed to info@epilepsylifestyle.org.uk or posted to our registered address, PO 3204, Eastbourne, BN21 9QT.
  7. Proof of entitlement to Child Tax Credit or Income Support must be submitted to accompany the application. This can be emailed to info@epilepsylifestyle.org.uk or posted to our registered address, PO 3204, Eastbourne, BN21 9QT.
  8. Once the monitoring system has been received by you, you have full responsibility for maintenance and upkeep if applicable.
  9. By signing this application you agree to all guidelines and the disclaimer above.