Application Form

Applications are currently closed due to lack of funding. Please keep checking back to see when they are re-opened

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, applications can be made at any time.

2) We accept applications for any diagnosed patients of any age with any form of epilepsy.

3) Epilepsy Lifestyle will respond to you with a decision as soon as possible.

4) Beneficiaries can only apply for one type of monitoring system or the Anti-Suffocation Pillow.

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.

7) Proof of entitlement to Child Tax Credit, Income Support or Employment Support Allowance must be submitted to accompany the application.

8) If either of the above accompanying documents (point 6 & 7) are not received with the application form, the application will be put on hold until they are received.

9) Once the monitoring system has been received by you, you have full responsibility for maintenance and upkeep if applicable.

10) In line with our grant making policy you will be required to complete and return a feedback form approximately 3 months after receiving your night time monitor.

11) By submitting this form you agree to all guidelines and disclaimer outlined on this page.