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Apply for Medication, Emergency Care & Surgery Assistance

We understand that epilepsy doesn't just affect your health—it impacts your livelihood. This program is for individuals and families facing the overwhelming costs of seizure care. There is no shame in asking for a safety net; we're here to help you breathe a little easier during the toughest moments.

01

Fill the Form

Complete the application below with your basic and medical information.

02

Attach Docs

Provide proof of diagnosis, bills/estimates, and financial hardship documentation.

03

Submit & Review

Our team will review your file and reach out. We focus on providing hope, one case at a time.

Seizin the Day: Application for Assistance

Applicant Information

We're here to support you. Please provide your contact details so we can reach out to help.

Please provide your current residential address below.

Residential Address
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