Welcome to THE Epilepsy Association Client Services.
THE Epilepsy Association provides case management and discounted or free epilepsy health care services to those in need. This page contains information about our client services and case management. We also provide the forms for download that you may complete prior to your first visit to save time.
As a convenience to you, while applying for services with us, we have provided you with the following information regarding what you will need to bring with you to your intake appointment as well as some forms that will need to be completed.
Do your best to complete as much as you can in advance in order to save you time when you come in. Don’t worry, your Case Manager is here to help you with any questions you may have, or, completing anything you may have difficulty with when you come in for your appointment.
In order to do your eligibility as quickly as possible with no delays please bring with you when you come:
- Proof of U.S. Citizen (example, birth certificate) or your non-citizen documentation
- Proof of your identity and Florida residency (Florida Drivers License or Florida ID Card)
- Your Social Security Number
- Any other insurance coverage information, private, Medicaid, Medicare, VA, etc. if any.
- Any previous medical records you may have and any contact information such as telephone numbers, addresses, etc. for any of you medical providers (doctors, hospitals, etc.).
In addition we will need proof of ALL income for ALL family members in the household. Income includes any:
- Social Security (SSA) check
- Child Support
- Employment – ALL JOBS (salary, wages, fees, tips, bonuses, overtime, pay and commission)
- Foster Child and Shelter Child Payments
- Interest or dividends (from savings, investments, trusts, estates, bonds, stock sales, etc.)
- Living off savings
- Lump sum payments
- Military leave and earnings statement (LES)
- Rental income
- Retirement (pension, annuity, or retirement amount)
- Public assistance (welfare, food stamps, job training assistance: Not used for WIC eligibility)
- Student grants or loans
- Unemployment or Worker’s Compensation
- Veteran’s pension benefits
- Regular cash support contributions from any source assisting you
Please print the packet and complete as much as you can prior to your appointment and bring them with you. (Comes in one zipped folder.)
Orlando Office (Orange, Seminole, Osceola County) 109 N. Kirkman Road, Orlando, Florida, 32811 – Download all Forms
Melbourne Office (Brevard County) -1600 Sarno Rd # 119, Melbourne, Florida, 32935 – Download all Forms
Thank you and we look forward to being of service to you.
109 N. Kirkman Road, Orlando, Florida, 32811
1600 Sarno Rd # 119, Melbourne, Florida, 32935