If you are a Social Worker, or other member  of the treatment team, you are aware that A Mother's Kiss is one of the easier organizations to work with.  We are highly aware of the intricacies of some of the organizations that you must work with on behalf of your patients and their families.  We try to make things as easy as possible for you.      Request Form

This section of our site is designed to help social workers expedite requests for assistance to our organization.  Our request submittal can be faxed to our offices.  It is available below. If you have any questions regarding our policies, please contact our offices at (631) 924-2770.

To submit a request, please fax the Request Form to 631-924-0771, Attention: Geri Garofallou.