Referrals - Dreams of a Lifetime

Refer Now

Dream Guide

At this time we are accepting referrals for patients who reside and/or are treated by a primary oncologist in the state of Florida.

Referrals can be made for patients who:

- are young adults
- have not previously received a dream or wish from a similar organization
- has an illness due to cancer that has placed the patient’s life in jeopardy

(Please note referrals are encouraged regardless of prognosis and dreams are sponsored at all stages of disease progression including diagnosis, treatment, remission, or palliation.)

If you have more questions regarding the dream granting process please click on the "Dream Guide" link visible in the column to the left of this text.

To initiate a referral please complete and submit the information below. Upon clicking submit, you will then be redirected to a page where the referral forms are available. To refer a dreamer please complete, print, and mail the forms provided. E-mail referrals are not accepted. Your information will be reviewed, and you will be contacted shortly. Family members, medical professionals, and social workers may also make referrals.

All of the dreamer's medical information is considered confidential and is not discussed with outside parties unless it is required for the dream and the patient has given consent.

* Your First Name:
* Your Last Name:
Relationship:
Email Address:
* Phone Number:	Please use the (xxx)xxx-xxxx format
* Address Line 1:
Address Line 2:
* City:
State:
* Zip Code:
* Referring physician:
* Physician's phone number:
Comments:
Terms of Agreement:	1.The patient or referring party agrees to refer the patient via the website and provide all necessary information at time of referral. a. This information includes the completion of the initial website form as well as the release form, patient information form and physician approval form. b. A physician must approve the Dream request via the physician approval form before the dream can be processed. c. The referring person must be the patient, the patient’s physician or his/her staff or a close family member/significant other (husband, wife or the equivalent) who has contact with the patient’s physician. d. Referrals via email, telephone or any manner other than that listed above are not valid and will not be pursued by the foundation. 2. Patient criteria as of 8/2007: a. Young adult is defined as between the ages of 18 and 29, however exceptions may be made on a case by case basis. We do not discourage anyone over the age of 29 from submitting a referral. b. Must have a “life-threatening” cancer diagnosis which is confirmed by the patient’s physician. c. The patient or their primary treating oncologist must reside in the state of Florida. d. Have not received a Dream or Wish from a similar organization. e. Must go through the appropriate referral process as listed above. f. Must be approved to go participate in their Dream by their physician. g. Must sign the release form. 3. Dream criteria as of 8/2007: a. Dreams cannot include monetary gifts or gifts of substantial monetary value. For example: cars, houses or payments towards these are not permitted. Also, Dreams of a Lifetime for Cancer Patients, INC. cannot assist you in contacting someone or some entity in order to receive monetary gifts or gifts of substantial monetary value such as the examples listed above. b. One additional person aside from the patient may be funded for a Dream if this is a reasonable request for the Dream and the maximum dollar amount allotted has not been reached by funding the patient alone. i. Any requests for additional persons (limited to immediate family members) to be funded must be approved by the Board of Directors and still must not exceed the maximum dollar amount allotted. c. The maximum amount that can be spent by Dreams of a Lifetime on a Dream is $2,000. i. This amount is subject to change based on the financial situation of the foundation. ii. Dreams of a Lifetime for Cancer Patients, INC. is not required to spend the maximum amount for any or each Dream. iii. Dreams may require board approval for amounts less than $2,000 prior to being granted. 4. Dreams of a Lifetime for Cancer Patients, INC. reserves the right without limitation or notice to determine which eligible patient referrals will be accepted. 5. Dreams of a Lifetime for Cancer Patients, INC. will grant Dreams on a first come first serve basis holding all of the Terms of Agreement listed above although we may not be able to help all patients referred.
By clicking the submit button, you and all affiliated parties certify that you have read, understand and agree to the Terms of Agreement as stated above.

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