Referrals Form

Please complete and submit the referrals application

RMHC Referrals

  • *All information must be complete or the referral cannot be processed. *All referrals must be submitted by medical staff. Families cannot refer themselves.
  • Patients must be 21 years old or younger for family to qualify for RMHC services.
  • If a family has medicaid, it is now always required that a Letter of Medical Necessity be submitted to their specific medicaid provider for them to be approved for lodging at the Ronald McDonald House. Thank you for taking care of this in advance.

  • Family MUST have a permanent address and MUST live 25 miles away from the Ronald McDonald House to qualify.
  • * RMH guests must be 18 years old or have a guardian present if they are minors.
  • *Family/friends of the patient who have been convicted of a felony crime may not be permitted to stay at the Ronald McDonald House.
  •   Yes
      No
  • *Parents with an open CPS case/investigation DO NOT qualify for RMHC services.

  • *The maximum number of people per guest room is six.