Monitor grant enquiry form

The Daisy Garland night-time breathing (SATs/epilepsy) monitor programme is set-up to help keep children with drug-resistant epilepsy safe while they sleep reducing the risk of SUDEP (sudden unexpected death in epilepsy). The programme is open to families living in the UK only.

If you live in the UK and your child has been diagnosed with epilepsy, is having regular seizure activity despite taking daily anticonvulsant medication and/or is on the ketogenic diet, you may be eligible to apply for a Daisy Garland monitor grant.

In order to assess your eligibility for a monitor grant, please complete this form and we will get back to you as soon as possible.

Parent/carer full name (required)

Address (required)

Email address (required)

Child’s full name (required)

Is your child under 3 years of age? (required)

Child’s date of birth (required)

Approximate date of your child’s first seizure? (required)

Has your child received an epilepsy diagnosis? (required)

Is your child taking daily anticonvulsant medication? (required)

If yes, how many anticonvulsants are they taking? (required)

Approximately how many seizures a week is your child having? (required)

Length of longest seizure? (required)

Have you considered the ketogenic diet for your child? (required)

Is there anything else you would like to tell us about your child and their condition? (required)

How did you hear about The Daisy Garland? (required)

Epilepsy nurseOther medical professionalFriends/familyFacebookTwitterThrough another charity

If so, which charity?

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