HOSPITAL STAFF/SOCIAL WORKERS ONLY
Please complete this form, being sure to include information for all persons requesting to stay.
All those over 18 years of age must have completed answers for the Yes/No questions in section 3.
All fields marked with an asterisk (*) are required fields.
If you have questions about this form, please contact us at (401) 274-4447.
Note: Please use only Google Chrome or Mozilla Firefox as your browser; Internet Explorer is no longer supported.
Our goal is to provide a safe & secure environment for all guests. The following questions are required of all adults requesting a stay at the Ronald McDonald House (RMH) Providence. Certain situations may require more information. The referring medical professional must provide additional details (at the end of this section) for any 'Yes' or 'Unknown at This Time' answers.
Please add a contact phone number for atleast 1 parent or guardian staying at the house This field is optional but we need atleast 1 phone number to reach you, when needed.
Please contact us if you have additional needs or questions at (401) 274-4447.
Thank you for submitting the referral. A Ronald McDonald House Charities of New England Providence staff member will contact you within 24 hours weekdays. Referrals received over the weekend will be responded to on the following Monday. If you do not hear from us by then-feel free to give us a call at 401-274-4447.
Ronald McDonald House Charities® of New England
250 1st Avenue Charlestown/Boston, MA 02129
45 Gay Street Providence, RI 02905
Tax ID #22-2760752
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