Welcome to our online application form. In order to view the form you will need to register or login above. The form will then appear below.
Alternatively, download a paper application form to fill out here.
To apply for a Special Day:
- You need to create a new account for each person applying. Therefore, if you are a healthcare professional then we suggest using a username relevant to your patient (e.g. firstname.surname).
- Create a password. This should be known to both the healthcare professional and the applicant so please use something you can both remember.
- Each part of the form needs to be completed with all required fields.
Sections 1 and 2 should be completed by the person for whom the application is being made – we cannot arrange surprise Special Days. Sections 3 and 4 should be completed by a medical professional – we will get in touch to verify the application.
You can fill out the forms separately. Once you have completed your section simply click Save and let the other person know that they can login with the username and password and complete their section. Once both sections are complete please click on Submit to Willow.
Not sure if you are eligible? View our Special Day eligibility details here.
If you need to speak to a member of the team please do call us between 9am and 5pm, Monday to Friday, on 01707 259 777. If you'd like any of our materials in another language, please email us at email@example.com.