How To Apply

Use the application form to apply to Intractable Epilepsy’s programme for funding medicinal grade cannabis (the “Programme”).

When processing your application and in the course of the Programme, we need to process certain personal data. All personal data we ask from you is absolutely mandatory for providing funding to you, although we may only collect some data with your free

and voluntary consent. Please read about how and why

we gather your personal data before you complete and submit this form

All information that you provide will be treated strictly in line with our Privacy and GDPR Policy which can be found below.

Intractable Epilepsy can only fund medicinal grade cannabis that has been prescribed by a clinician on the Specialist Register of the GMC and the prescription must be in in accordance with current UK Government legislation and regulations and NHS guidelines.

Our grant guidelines for the programme are below. Intractable Epilepsy will only consider funding where the medication has been prescribed for a minimum period of 6 months and that period has or is about to expire.

You can download the confirmation below.

Download Confirmation

Please print it out and have your clinician fill it in. Afterwards, please scan the confirmation.

You can send your Clinician’s confirmation via e-mail to the following address: Applications@intractable.org.uk

The Clinician’s confirmation is provided and uploaded by you and based on your explicit consent. This information is processed in accordance with our Privacy and GDPR policy. You can withdraw your consent at any time with future effect. Please be aware that the Programme must be discontinued if you withdraw your consent for the future.

Once Intractable Epilepsy has considered whether your application meets our minimum criteria for participation in the Programme, a member of our team will be in contact with you to take you through the next steps and discuss with you what grant funding can be offered and the details of how the grant will be made. Please note that the work of the charity is carried out by unpaid volunteers and the trustees will aim to respond to this application as soon as is practicable. Should we, in the course the application process or during the Programme request further data from you, we will process this data in accordance with our Privacy and GDPR Policy.

APPLICATION FORM

First Name Of Applicant

Last Name Of Applicant

Address If The Applicant Does Not Reside With The Patient

Phone

NAME AND ADDRESS OF PATIENT IF NOT THE APPLICANT

First Name Of Patient

Last Name Of Patient

Patient Address If Different From Applicants Address

I Confirm The Patient is Under Thirty Years of Age.

Name of dispensing pharmacy (please note that grant funding is by way of direct payment to the dispensing pharmacy and that funds cannot be transferred to any other organisation or to an individual)

Monthly Prescription Cost

upload confirmation

Upload File

I have uploaded my completed (signed) by clinician, confirmation form.

Thanks for submitting!

Intractable Epilepsy Ltd is a charity registered under charity number 1199192 and a charitable company limited by guarantee under company number 13019024. The registered address of which is Fir Tree Barn, Preston Road, Preston, PR4 3XB.

How To Apply

You can download the confirmation below.

APPLICATION FORM

NAME AND ADDRESS OF PATIENT IF NOT THE APPLICANT

Intractable Epilepsy Ltd is a charity registered under charity number 1199192 and a charitable company limited by guarantee under company number 13019024. The registered address of which is Fir Tree Barn, Preston Road, Preston, PR4 3XB.

Send us a message

Legal

Privacy Policy

Lottery Privacy Policy