Application for Admission
All patients must submit genetic test results, the medical bill, and the birth certificate of a child.

Patients with SMA please prepare to submit AVV test,
neurologist's note, and CHOP-INTEND score.

*To be considered, the child with SMA must be less than two years of age.

Please fill out this form
Your name and relationship to the child
Your email
Patient's name
Date of birth of your child (month, date, year)
Is the child on supportive therapy? * only for SMA
What supportive therapy is the child currently taking and at what dosage? * only for SMA
From what date your child has been taking supportive therapy? *only for SMA
What is the recent CHOP Intend score of your child? (provide the number) *only for SMA
How many hours per day your child is using non-invasive ventilation? (*only for SMA)
Please upload the birth certificate of your child, copy of an original document or translation
Please upload the genetic test of your child
Please upload the AAV test of your child *only for SMA
Please upload the doctors note of your child
Please upload the medical bill
By clicking on the button, you consent to the processing of personal data
and agree to the privacy policy
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