Evidence from a healthcare professional:

As a part of our application form you will need to provide a headed and signed letter from a healthcare professional providing confirmation and details of your limb difference. This can be a nurse, GP,  physio, registrar or consultant, who you see regularly and is familiar with your limb difference. 

This application form must contain the following:

• Letter header from the healthcare professionals place of work

• Telephone number of healthcare professional place of work

• Address of healthcare professional place of work

• Email address (if applicable) of the healthcare professional

• Brief confirmation of your limb difference, how it came to be and when it came to be. 

  • For example; Jane Doe is a left leg above knee amputee following an accident in 2017.

• Details of your relationship with this healthcare professional and how long you have been visiting them in relation to your limb difference.

  • For example; I am this patient’s GP and they have been registered at this practice for 3 years

• Details of your desired equipment/service/prosthetic and whether it is appropriate for your limb difference.

  • For example; This patient wishes to purchase a foot drop orthotic that is appropriate to their limb difference.

• Dated signature from the healthcare professional (can be signed electronically if required)

Please note; we only require brief factual information by way of support for the application.

To help you with this we have provided a letter to give to your healthcare professional and an example letter and this can be accessed here:

Letter for your healthcare professional and example letter

Evidence of your chosen item:

In order for us to understand in more detail what prosthetic, service or equipment you are applying for funding towards you will need to supply evidence that clearly shows the supplier, price and item you are looking to purchase. This could be a quote, a magazine clipping, a screenshot from a webpage or similar. Please see examples below.

Evidence of held funds for any remaining balances:

If you are applying for an item of equipment, a service or a prosthetic that costs more than the yearly grant limit, you need to provide additional evidence to support your application.

If you are requesting funding for specialist equipment/service/prosthetic costing more than the application grant limit (this is subject to change on a yearly basis) you need to provide evidence that you hold 50% of the remaining balance. This is so that we know you are able to purchase within the 6 month holding period following successful application.

Example;

The application grant limit is £5000 and you are requesting funding for specialist equipment/service/prosthetic costing £6000. You must have raised already £500 of the remaining £1000 above the £5000.

This evidence can be a in the form of a bank statement, balance receipt or similar. It must clearly show that the purchaser/applicant is in ownership of the required additional funds.

The grant limit can be found on the apply page of our website, here.