Request for Gift of Love
Please fill out the fields below to refer* a patient, family member or friend to be considered for a Gift of Love:
Note: You may have to switch to Chrome (not Internet Explorer) in order for the “Date of Diagnosis” field to populate correctly. If you continue to have problems, you can also submit without filling in the date.
Chix 4 a Cause respects and upholds the confidentiality of all people referred to us for help.
* All referrals are evaluated by the Gifts of Love team and then brought before the Chix 4 a Cause Board of Directors for approval of a one-time gift. You can expect to hear from a Gifts of Love team member within two weeks.