How to Apply
To receive a Wish respite, the physician, provider or care organization identifies a parent who has a life-threatening illness. The program is only open to first time Wish Recipients.
Heres How It Works
Care taker or potential wish recipient may click on MOL Wish Request Application Packet at the bottom of this page or call Memories of Love at 904-596-2789, or toll free at 800-625-1566 for an application packet.
Physicians may click on MOL Medical Authorization
The wish recipient is asked to do the following:
- Write a letter expressing what this trip would mean to you and your family, include a family photo and a favorite family recipe.
- Complete the Memories of Love application form
- Send the completed/initialed/signed form to Memories of Love. The forms may be faxed to 904-636-7780 and the original application packet must be sent to:
Memories of Love
4932 Sunbeam Road
Jacksonville, FL 32257
(904)596-2789
info@memoriesoflove.org
For additional information please call Memories of Love 904-596-2789 or 800-625-1566.
Forms:
- Memories of Love Wish Request Application Packet (includes Memories of Love Medical Authorization and HIPPA forms.)
- Memories of Love HIPAA form
- Memories of Love Medical Authorization form