Instructions

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 MEMORIES OF LOVE Wish Recipients. 

Heres How It Works

The physician, care taker or potential wish recipient may click on the appropriate forms 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.

The wish recipient is asked to do the following:

1. Write a letter expressing what this trip would mean to you and your family, include a family photo and a favorite family recipe.
2. Complete the Memories of Love application form
3. 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 HIPAA form

• Memories of Love Wish Request Application Form  (family photo required)

• Memories of Love Medical Authorization