Medical Wish Referral

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Thank you to all the health care professionals who refer their patients to Make-A-Wish®. By referring a child, you help us get closer to achieving our vision of granting every eligible child's wish.

The purpose of Make-A-Wish is to grant the wish of each child between the ages of 2½ and 18 who has a life-threatening medical condition, i.e., a progressive, degenerative or malignant medical condition that has placed the child's life in jeopardy.

Health care professionals, both medical and psychosocial, can refer a child using this Medical Referral Form. Take the first step in referring your patient.

Step 1:

The first step in referring your patient is to review our Eligibility Guidance Sheets (see right sidebar), which describe the medical conditions that typically qualify a child for a wish.

Please note that there may be medical conditions not described on these sheets that can also qualify as a life-threatening condition and can be considered on a case-by-case basis.


Step 2:

The next step is to certify that you are an authorized health care professional who has direct knowledge of the child's medical condition. This form is for use by medical professionals only. If you are not a health care professional involved in the treatment of the child you are referring, please visit our Referral Inquiry Form.

I certify that I am a health care professional qualified to refer my patient to Make-A-Wish.




Click NEXT to be taken to Step 3 — the Medical Referral Form.


Please certify that you are a health care professional qualified to refer your patient


Guidance regarding eligibility within subspecialty departments.

Please click to learn more about:


Questions? Contact Mission Resources
at Make-A-Wish America.
(602) 279-9474, ext. 3209
4742 N. 24th St. Suite 400 Phoenix, AZ 85016 800-722-9474