Who Makes Up Your Family Ambassador Team?

Each Ambassador shares a common desire to offer support to another person who is living with LGS and its daily challenges.

Request Form

By submitting this secure online request, I agree that the information I have provided for myself or my child may be used by the LGS Foundation and the Family Ambassadors solely for my participation in the Ambassador Support program. I understand that the Ambassador is a volunteer for the LGS Foundation and their opinions and comments reflect their personal experience in the diagnosis, testing and treatments. They are not necessarily the views of the Foundation or medical professionals.  I certify that I am 18 years or older. I may revoke this consent by contact the LGS Foundation at info@lgsfoundation.org.

First Name

Last Name

Address 1

Address 2

City

State

Zip

Email

Phone

(list that checks off the relationship to the lgs person) parent, etc

Name of LGS loved one

Age of LGS loved one

Tell us about the reason for your request and how we can help. What is your most pressing need that you are seeking support for?

Is this a referral from a professional?

Any additional comments:

Thank you for submitting your request to our Ambassador team. In order for us to best respond to your request please fill out the form below with details about how we might assist you.  Tell us your story, about your child and ask any question you may have.  An Ambassador will follow up via email within 2 business days.

Please note Ambassadors are not medical professionals, we are parents who are willing to share experiences and lend a hand. We are not able to review any diagnostic tests or provide medical advice and we are unable to provide financial support.