The DSF Patient Assistance Grant Program offers grants to patients with Dravet syndrome and related SCN1A epilepsies for necessary medical equipment, therapy devices, and educational aids associated with these conditions that are not covered through private insurance or other assistance programs. This program is open to all patients worldwide who are members of the DSF Family Network. The program closes each year on December 1st or once funds are depleted. Any remaining funds are rolled over, with the program re-opening each year on January 1st.

Applications will be reviewed and approved on a first-come, first-served basis. An applicant may apply once per grant cycle with a yearly maximum of $1,500 and a life-time award maximum of $5,000.

Your application packet should include the following documentation:

  • Completed application
  • A recent letter from the child’s physician or health care professional explaining the medical necessity of your request
  • A letter of denial from the insurance provider stating that the requested equipment and/or service was denied (when possible)
  • A W2 or other form of ID that verifies your identity (with SS# information redacted)
  • Any other documentation pertaining to the nature of your request. All information is kept confidential.
  • Please DO NOT submit personal medical records, such as a genetic testing report or medical charts.

Applications that are incomplete or missing requested additional information will not be placed in queue for review until complete. Incomplete applications expire after 60 days.  All applicants will receive an email stating approval or denial of their application. Denied applicants wishing to re-apply must provide additional documentation of a change of status in circumstances or that other alternatives have failed. We request up to 45 days to review your application. You can submit your application online below, or a printable application is available in English and Spanish.

Familias de habla hispana: si necesita ayuda con el Programa de subvenciones de asistencia al paciente, envíe un correo electrónico a info@dravetfoundation.org.

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Application for Caregivers
Application for HCPs

Application for Caregivers

Your application packet should include the following documentation:

  • Completed application
  • A recent letter from the child’s physician or health care professional explaining the medical necessity of your request
  • A letter of denial from the insurance provider stating that the requested equipment and/or service was denied (when possible)
  • Proof of all income (including your most recent W2 form)
  • Any other documentation pertaining to the nature of your request All information is kept confidential.

Name(Required)
Are you a member of the DSF Family Network?(Required)
Have you previously applied to DSF's PAG program?(Required)
Address(Required)
MM slash DD slash YYYY
Gender(Required)
(include primary and secondary, if applicable)
(Provide exact name of equipment/service; name of manufacturer or provider; and the name and contact information for the vendor. If available, please attach brochure and/or photos. If you are requesting more than 3 items, please contact Jamie prior to submission.)
Please research the cost of your item(s) before submitting your application. An estimated cost must be entered, or your application will be rejected.
Please enter a number greater than or equal to 1.
Hidden
Single PDF containing all supporting documentation (optional)
Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.
Max. file size: 128 MB.
Confirmation Checkbox(Required)
Liabilty Waiver(Required)
Disclosure of Health Information(Required)
This field is for validation purposes and should be left unchanged.

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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