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Hospital referral

*Please note: our individual funding for integrative therapies is only available for cancer patients in New England, or cancer patients outside of New England who have relapsed or are transitioning to/on hospice.*

Thank you for referring a family to Lucy's Love Bus! We are looking forward to working with them; please fill out the information below as able and allowed, and we will be in touch with you or the family directly to discuss the availability of our funding and next steps. (The fastest way for us to help a family is to have them complete our application! We will get in touch with the family and send them the application, which is needed before we can pay for services, so directing the family to our application is the fastest way to help them get started with services!)

Please get in touch with Jackie directly at jackie@lucyslovebus.org or 978-764-4300 if you have any additional questions. 
The BEST way to help the family is to direct them to our application at lucyslovebus.org/application. This is the fastest way to get them connected to therapies.

Family Referral
Your name
Your job title/connection to family
Hospital/organization
Your phone number

The following are questions about the family and child so that we can get in touch with them as soon as possible. Please fill out as much of the following information as you feel comfortable sharing, and only with the family's permission. Knowing a child's state of residence will allow us to immediately assess how much funding we can offer the child, and additional information such as age and therapies of choice will allow us to begin the process of searching for a perfect person to work with them.

This is the referral application for integrative therapy support (paying for massage, acupuncture, dance, swim, therapeutic horseback riding, etc). In 2021, we are offering monthly support via gift cards for grocery stores, pharmacies, and gas stations. To refer a family for this financial support, please click here. We are no longer able to pay bills, and will not be able to offer gift card support after December 2021.

Patient's Name
Patient's DOB
If the patient is over the age of 18, please advise if we should contact them directly, or contact the guardian.
Patient's diagnosis
City/town of residence
State of residence
Name of person to contact
Relationship to patient
Contact's email
Contact's phone number
Contact's preferred method of contact?
Contact's preferred language
Patient's chosen therapies?
This referral form is so that we can get in touch with a family, tell them more about our programs, and have them complete a full application. The family will still need to complete the full application before moving forward. Directing them to the full application is the fastest way to connect them to assistance. This form is also for integrative therapy support only, and Jackie Walker should be contacted for any other type of potential support to determine availability and eligibility.
  • We must secure a medical permission form signed by the child's oncologist clearing his/her participation in the therapy of his/her choice. Please click here to download that permission form; it can be sent to us by fax/email/mail separately from their complete application from your directly, but must be received before the child begins services.

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