Referrals, out-of-state

Child's Name: *

Referrals

Out-of-State Hospitals

If you know of a family that would benefit from a Hope Tote, contact us using the convenient on-line form..

Please note: Our protocol for a qualifying referral is that the child has at least an additional 4 weeks stay ahead of them. Our totes are very comprehensive and we make this designation based on our turn-around time of about one week as well as utilizing our resources and serving families appropriately.

All Fiona's Hope Totes for families at non-Minnesota hospitals suggest a small donation of $25 to help us cover the cost of shipping (as our totes are quite large and heavy). This is not required but very appreciated.

If you would like to sponsor an entire tote, sponsorship for a Hope Tote, filled with all the comforts of home, is a suggested donation of $100.

Important that you include the e-mail addresses of the recipient(s) and the referring person so that we can verify the delivery details.

Please note that all information is confidential and will only be used when creating a custom Tote and for delivery information.

Comments

Referring person's name *

Related Face Book/Caring Bridge page if applicable

Parent's e-mail *

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Location, city and state *

Hospital Name and Unit *

Diagnosis *

Parents' Name(s) *

Child's Age *

Sibling Totes

In order to focus on our growing Hope Tote program, our sibling totes program has been suspended indefinitely. Thank you for your understanding.

Referring person's e-mail *

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