In hospital services


- provided by request** from medical professional working directly     with the family

- services are provided to parents, caregivers or patients in the hospital room or other space defined by medical staff,

- pre-treatment questionnaire** is needed for all recipients

- minor patient needs signed consent form** by her/his legal guardian

- medical consent** is needed for all services provided to the patient


** Links to all forms are located at the bottom of this page


event services


- provided by Request Form** from Event organizers

- medical consent** is needed for all services provided to the patient

- pre-treatment questionnaire** is needed for all recipients
- minor patient needs signed consent form** by her/his legal guardian
- medical consent** is needed for all services provided to the patient

** Links to all forms are located at the bottom of this page

Moment of Grace Letter of Recommendation

HIPAA Privacy Authorization Form

Request Form for In Hospital Services

Request Form for Event Services

Pre-treatment Questionnaire

Minor Guest Consent Form

Doctor's Consent Form for Patient









In Spa/salon services

Moment of Grace  provides services and care for parents and caregivers of critically ill children utilizing 3 platforms:


- in spa/salon services 

- services during charitable events in coordination with other non-profit organizations

- services provided in the hospital to patients themselves and/or their parents and caregivers staying with them


Each recipient of MOG services (in spa or during an event) receives a take home goody bag.  Parents/caregivers that are staying with their children in the hospital receive care package to help them during their stay. All packages and goody bags are provided based on availability. Any donations for the goody bags or care packages are greatly appreciated - please visit "How to Donate" tab if you are interested in donation.



* Special "Prescription Pads" are available for the children to write their own prescription for mom or dad. This is to encourage parents or caregivers to give themselves moment of respite, it also provides children with something little to give to their parents. Please see a sample below and contact us if you would like us to send you some! 


Step 1 | Referring Coordinator (i.e. social worker or doctor) contacts Moment of Grace with request for service(s) for selected parents or caregivers using the Moment of Grace Letter of Recommendation and HIPAA Privacy Authorization Form (please see the link below). *

Step 2 |​ Moment of Grace will contact the recipient of the service(s) to specify the geographical location, preferred days/times and the selection of services.

Step 3 | Moment of Grace will facilitate the initial* appointment with the provider, Spa or Salon and will provide the details to the recipient.

Step 4 | If applicable confirming email generated by Spa/Salon/Provider booking system will be sent to the recipient and Moment of Grace.

Step 5 | Spa/Salon/Provider will provide a moment of grace to those who give the most…


Step 6| Moment of Grace will provide a tax deductible documentation to the provider.


*Should the recipient need to re-schedule the initial appointment he/she will need to do so directly with the spa/salon/provider.


GENERAL PROGRAM GUIDELINES 
(from our spa/salon service providers)

  • Guest Recipients (maximum of 2) may receive one spa service per visit per month.
  • Both guests must be either parents or guardians of critically ill child or patient him/herself.
  • Patients must have Doctor's consent to receive spa services.
  • Minors guests 14-16 years must be accompanied by their parent or guardian who must remain on the premises during the service.
  • Minors guests 14-18 years must have a signed consent form from their parent or guardian.
  • Donated spa services are non-transferable, have no cash value and cannot be exchanged for other services or products.
  • Guest recipients must complete a Pre-treatment questionnaire prior to receiving their services.


Note: Spa guidelines vary from participating spa/salon service providers. Please contact us if you additional questions or concerns.