Cure SMA Medical Binder Request Form

Please fill out the form below to request a Cure SMA Medical Binder. Upon submitting the request form below, we will ship out your binder in the order it was received. Please email c ommunitysupport@curesma.org with any questions. Also, please note we are unable to ship to PO boxes.

1. I acknowledge I have read through the eligibility criteria below and meet all of the requirements.

Eligibility Criteria:

Must have confirmed SMA diagnosis.
Must live within the US.
Legal guardian can request device on behalf of their affected child if applicant isn’t old enough to fill out their own application.

*This question is required.

Are you affected by SMA or are you filling out this request on behalf of a person with SMA? *This question is required.