Who is completing this form?
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Please give a short description of the recipient's Illness:
How did you learn about the #DREAMDAY program?
Please share about how the recipient is "Living The Dream" despite battling a life-threatening illness.
Please list a few of your favorite bands, artists, entertainers, influencers, athletes, etc.
Does the recipient have problems with communication?
MEDICAL PROFESSIONAL INFORMATION
Medical doctor, specialist, or general practitioner. This information is used to confirm your condition.
Medical Professional's Name:
Medical Professional's Address:
Medical Professional's Phone:
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This form was created inside of Living The Dream Foundation.