Other exceptional circumstances forms

A handful of medicines require a different form.

Download the relevant exceptional circumstances form

Alpha tocopheryl acetate (vitamin E) with/or retinol (vitamin A) funding application form [PDF, 221 KB]

Brentuximab application form [PDF, 104 KB]

Multiple sclerosis MS application for grandparented patients [PDF, 105 KB]

Paediatric oncology/haematology notification form [PDF, 342 KB]

Prednisolone oral liquid funding application [PDF, 255 KB]