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Share the Referral Inquiry Form

Share our online inquiry form with someone who can refer a child who lives in the United States or one of its territories.

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Make-A-Wish accepts referrals from:

  • Parents or legal guardians
  • Healthcare professionals
  • Children being treated for a critical illness
  • Family members with detailed knowledge of the child's current medical condition


Do you know someone who can initiate a referral inquiry on behalf of a deserving child?


Share our Referral Inquiry form with them.

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Make-A-Wish® Mississippi
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(601) 366-9474
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Make-A-Wish® Mississippi, Southern Region - Gulfport
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