Cover image of Fabry disease initial application form


Life Saving Drugs Program – Fabry disease – Initial application

We are working to improve this form, which currently does not display correctly in all web browsers. In the meantime, you can use either the PDF or Word version by:

  • Saving the PDF to your hard drive and opening it with your PDF software. You can then type into the fields before printing, signing and returning to us.
  • Downloading and printing the Word version. You can fill it out by hand, sign and return to us.

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Publication date: 
7 October 2020
Last updated: 
8 December 2021
Publication type: 
Intended audience: 
Health sector

This form includes:

  • information about the application process and timelines
  • treating physician’s responsibilities
  • privacy notice and patient consent
  • health professional details
  • dosing details
  • eligibility requirements and test results
  • treating physician’s declaration
  • application checklist.