Refer a Child

Local Houstin area Hospital patients who qualify for a Kiss of HOPE® may be referred to our program by a hospital’s social worker.  However, if your child meets the following requirements and is seen at another hospital, please fill out the form below.

  • Aged 0-21 years old
  • Resident of Texas
  • Located in the Houston area and surrounding counties
  • Diagnosed and in a doctor’s care for one of the below brain/spine tumors
Diagnosis will be confirmed by the patient’s attending physician. Please provide the following: