By completing the form below, you’ll be entered into our secure, coordinated network of community resources, powered by Unite Us, that is available to help. A specialist will contact you after you submit the form.

If you are looking to explore resources immediately, check out:

Submit your request below.  You will receive a response from Epilepsy Alliance America within 24-48 hours of your submission.

Please fill this form out on behalf of the individual in need. If your child is in need of services, please fill out the form with the child’s information.

Please Note: We are not medical professionals and cannot review any diagnostic tests (like EEGs) or provide medical advice.