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MEDICAL PROFESSIONAL or SOCIAL WORKER
A
Medical Professional or Social Worker should complete the REFERRAL FORM (this is
the first page of the full application) and the MEDICAL ELIGIBILITY form.
Wishes & More requires that the
potential wish family be made aware that a wish request is being submitted.
When
Wishes & More
receives the
completed REFERRAL FORM and the approved MEDICAL ELIGIBILITY FORM from the
potential wish recipient’s doctor, the complete APPLICATION FORM will be sent to
the potential wish recipient’s family.
When the completed wish
APPLICATION FORM has been returned to
Wishes & More,
the family will be contacted by the Director of Wish Services.
The completed form should be returned to
Wishes & More
by fax or regular mail.
To get the
printable form,

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