Comprehensive Care Center Application

To qualify as a Lennox-Gastaut Syndrome (LGS) Comprehensive Care Center, the center is expected to:

Offer a multidisciplinary approach for the treatment of LGS/DEEs
Have a high concentration of expertise and related resources centered on LGS/DEEs
Demonstrate a strong knowledge base and familiarity with LGS/DEEs
Commit to furthering clinical knowledge of LGS/DEEs through collaboration with others, including the Foundation
Have involvement in studies and/or clinical trials for LGS/DEEs and are knowledgeable about new treatments and cutting edge research.
Additionally, to continue to qualify to be listed as Comprehensive Care Center by the Foundation, the center is expected to participate in LGS Foundation-sponsored fundraising and educational events. For example, this includes attending the biennial LGS Foundation Family and Professional Conference, local fundraising events, and online professional education programs.

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Your Information

First Name Last Name

Email Mobile Phone

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Institution/Center Information

Institution

Institution Address Institution Address Line 2

Institution Postal Code Institution City Institution State/Province

Institution Phone

Additional Information

Institution Website

Clinic or program name, if applicable (Optional)

Clinic Lead Name (please include professional designations)

Clinic Lead Title

Contact Name or Dept for Appointments

Phone Number to Schedule Appointments

Email to schedule appointments (if available) (Optional)

Please select all specialists or services that your institution offers for LGS patients.

If you selected "Caregiver support services" and/or "other" above Please elaborate on caregiver support or other services you offer to the LGS community. (Optional)

The LGS Foundation requires that Comprehensive Care Centers offer a multidisciplinary approach for the treatment of LGS. Please address how your center meets this requirement.

The LGS Foundation requires that Comprehensive Care Centers have a high concentration of expertise and related resources centered on LGS. Please address how your center meets this requirement.

The LGS Foundation requires that Comprehensive Care Centers demonstrate a strong knowledge base and familiarity with LGS. Please address how your center meets this requirement.

The LGS Foundation requires that Comprehensive Care Centers have a commitment to furthering clinical knowledge of LGS through collaboration with others, including the LGS Foundation. Please address how your center meets this requirement.

The LGS Foundation requires that Comprehensive Care Centers have involvement in studies and/or clinical trials for LGS and knowledge about new treatments and cutting edge research. Please address how your center meets this requirement.

Comments or Questions Please let us know if you have any questions or have additional information you would like to add to your listing. (Optional)