Healthcare Referral

Refer a Family for Compass to Care’s Travel Support

Thank you for referring a child to Compass to Care for support.
Our application process has two steps:

  1. The child’s social worker, nurse, or oncologist must submit a referral.
  2. After we receive the referral, the parent/guardian will receive a link to complete the application for travel support.

Whichever form is submitted first, our system will automatically email the link for the other required form.

Travel Expenses Compass to Care May Fund

If approved, we can provide direct payment or help families receive Medicaid payment for:

Airfare • Gasoline • Parking Fees

Lodging • Taxi/Uber/Lyft • Train Fare

Requirements Before Referring a Family & Travel We Do Not Support

  • Before submitting a family for support, please take a moment to review all criteria and requirements on our Patient Referral page. This includes information about which families qualify, what expenses we can and cannot support, and the responsibilities of referring social workers.

Child Referral for Compass to Care Support

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Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character
Child Information


CHILD TRAVEL SCHEDULE:  Please provide a detailed description of the child’s treatment plan that will necessitate travel for the family. THE INFORMATION PROVIDED BELOW WILL DETERMINE THE FUNDING LEVEL FOR YOUR PATIENT. SO PLEASE BE SURE IT IS AS ACCURATE AS POSSIBLE. 

Parent/Guardian Information




Medical Provider Details


Your Information




Enter Your Name
Save my progress and resume later | Resume a previously saved form

Contact Information

Child Referral for Compass to Care Support

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character
Child Information


CHILD TRAVEL SCHEDULE:  Please provide a detailed description of the child’s treatment plan that will necessitate travel for the family. THE INFORMATION PROVIDED BELOW WILL DETERMINE THE FUNDING LEVEL FOR YOUR PATIENT. SO PLEASE BE SURE IT IS AS ACCURATE AS POSSIBLE. 

Parent/Guardian Information




Medical Provider Details


Your Information




Enter Your Name
Save my progress and resume later | Resume a previously saved form

Contact Information