Please complete the following form to express your interest in an Epilepsy Assist Dog.  Please note the minimum age for applications is 16 years old.  There is no cost to the recipient for the supply, placement or training of a dog.  Once the dog is living with the recipient and the dog has been tested for  public access, food and vet fees are to be paid for by the recipient.

Once we have received the completed form, it will be assessed by our neurologist on the Trust Board  and she will contact your neurology specialist.  We will keep you informed as to progress but please be patient, it is not a quick process. 

Click here to download the form.