Patient Assistance Program Application

Epilepsy Alliance Louisiana will review applications for patients for assistance related to the care of a person with epilepsy.  Requests will be granted based on need and availability of funds. 

Eligibility:

To be eligible for financial assistance, a patient should fill out an application form and submit it to the case manager or other appropriate staff member. EAL will not review applications if funds are unavailable.  

Priority will be given to the following types of requests:

  • Travel assistance for second/ expert opinion or speciality care . 
  • Financial assistance for seizure detection devices or medical devices (i.e. helmets, wheelchairs, etc).

EAL is currently unable to approve the following requests through this program:

  • Requests related to service or support animals. 
  • Requests for travel to conferences or other activities.
  • Requests for scholarships. 

Applications will be reviewed and approved or denied based on the criteria listed above and funds available. Additional information may be requested from the patient to better understand the application. 

Request fulfillment:

Financial requests will be fulfilled by payment to the authorized entity whenever possible. 

Financial requests for gas or other travel expenses may be provided in the form of gift certificates. Please list preferred gas stations, hotels, etc in application. 

Amounts may be granted in partial fulfillment of that requested. 

Disclaimer: 

EAL does not guarantee any medical or other outcome related to application requests and fulfillment of a request does not necessarily represent endorsement by or an official position of Epilepsy Alliance Louisiana. Advice regarding specific treatment or care of a patient should be obtained through consultation with a qualified medical professional.

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