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Referral Inquiry Form

This inquiry form is the first step to receiving a wish – it is not confirmation of eligibility for a wish. Your information will be forwarded and you will be contacted by a member of our wish-granting team.

Relationship to child

Your information

We value your privacy and will not share your personal information.

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Please confirm your email address. We want to make sure we can respond to your request.

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Who can refer a child

Medical professionals, parents, legal guardians and potential wish kids can initiate the referral process.

Find out how to refer a child if you don't fit this criteria, or if the child lives outside of the United States and its territories.  

Who is eligible

A child with a life-threatening medical condition who has reached the age of 2½ and is younger than 18 at the time of referral is potentially eligible for a wish.

Read more on eligibility criteria for a potential wish child.

Make-A-Wish® Orange County & the Inland Empire
3230 El Camino Real
Suite 100
Irvine, CA 92602-1389
(714) 573-9474

Make-A-Wish® Orange County & the Inland Empire, Riverside Office
1650 Spruce
Suite 100
Riverside, CA 92507
(951) 321-0179