COVID-19 PPE Package Request Form


Please fill out the form below to request a Cure SMA COVID-19 Personal Protective Equipment (PPE) Package. Upon submitting the request form below, we will ship out your package in the order it was received and as supplies last. Please email with any questions. Also, please note, we are unable to ship to P.O. boxes.

Eligibility Criteria:

  • Package is provided to individuals with spinal muscular atrophy (SMA) or a legal guardian of an individual with SMA.
  • You must have a confirmed diagnosis of SMA.
  • Must live within the United States.

2. Applicant's Contact & Shipping Information:















Question - Required - Affected Individuals Birthdate:

Question - Required - Affected Individuals Diagnosis Date:


As part of the application for this support program, below are a few questions regarding how you or your family have been affected by the current global pandemic. This is part of Cure SMA's efforts to stay current with the impact COVID-19 is having on the SMA community so we can best meet your support needs. Completion of these questions is required.

Question - Required - Has your child (or you if affected with SMA) had any of the following? (Check all that apply.)


Question - Required - Has your child (or you if affected with SMA) experienced any of the following due to COVID-19? (Check all that apply.)



Question - Required - Please check all that apply to you:



(Maximum response 255 chars, approx. 5 rows of text)

   Please leave this field empty