Epizelus
WE'RE HERE TO HELP!

REQUEST SUPPORT

Epizelus is here to guide you through your healing journey.

If you are seeking funding for PTSD treatment please use the provided form.

To be considered for funding through Epizelus, applicants must provide verifiable documentation confirming both military service and a service-connected diagnosis of Post-Traumatic Stress Disorder (PTSD).

PTSD must have been diagnosed or documented during or as a direct result of military service and reflected in official military or Department of Veterans Affairs (VA) records.

By submitting this application, you acknowledge and agree to provide the required documentation listed below. Incomplete applications or failure to provide adequate documentation may result in delays or denial of funding.

All submitted documents will be handled confidentially and used solely for the purpose of determining eligibility.

Acceptable Proof of Service documents include:

  • DD Form 214 (Certificate of Release or Discharge from Active Duty)

  • Military ID (active duty, reserve, or retired)

  • VA-issued identification card (Veteran Health Identification Card)

  • Official service records or discharge paperwork

  • Letter of service verification from a commanding officer or military unit (if active duty)

Acceptable Proof of PTSD diagnoses include:

  • VA Disability Rating Decision Letter indicating PTSD as a service-connected condition

  • VA Benefits Summary Letter listing PTSD with a service-connected rating

  • VA medical records documenting PTSD with reference to military service

  • Military medical records (in-service records) showing PTSD diagnosis or related behavioral health documentation tied to service

  • Line of Duty (LOD) determination or equivalent documentation linking condition to service

  • Medical Evaluation Board (MEB) / Physical Evaluation Board (PEB) records reflecting PTSD or related conditions

Please be aware that processing requests my take several weeks. We ask that you provide the name of your preferred provider or clinic. Kindly note that Epizleus does not provide clinic or doctor referrals. The provider you indicate on your form must provide the service you are requesting.
Name Today's date E-mail Branch of Service Date of PTSD diagnoses
Funding requested for (PLEASE CHOOSE ONE ONLY))
Stellate Ganglion Block
Ketamine
Psychotherapy (talk therapy)
TBI treatment
Provider's name and contact Upload your proof of service AND PTSD diagnoses
Choose file
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