For a patient with Dravet syndrome to participate in the DSF Birthday Buddies Club, the parent must be a member of the DSF Family Network. If you are unsure if you are a member of the DSF Family Network, you can email Karen prior to filling out this form.

At this time, the DSF Birthday Buddies Club is only available for Dravet syndrome patients in the United States. Patients of any age may participate.

Birthday Buddies Registration

Parent or Guardian Name*(Required)
Email Address(Required)
I am a member of the DSF Family Network*(Required)
Only registered members of the DSF Family Network may participate in the DSF Birthday Buddies Club. If you are not registered, you will be contacted to complete the form before your child can be added to the Birthday Buddies Club.
Patient Name*(Required)
Hidden
MM slash DD slash YYYY
Address where package should be mailed*(Required)
Jazz Pharmaceuticals logo

This program is sponsored through an unrestricted grant from:

The information collected by Dravet Syndrome The information collected by Dravet Syndrome Foundation will not be sold or distributed outside of DSF and is used solely to verify identity and assist with communication. Questions or concerns can be directed to our team. 

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