Welcome to our friends in the healthcare community!

If you are a Social Worker, or another 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.

This section of our site is designed to help social workers expedite requests for assistance to our organization. Our request form can be faxed to our offices.

If you have any questions regarding our policies, please contact our office. To submit a request, please fax the Request Form to our office at:

(631) 924-0771, Attention: Geri Garofallou 

Our form can be downloaded by clicking the button below.

All information will be held in the strictest of confidence.

Download the Assistance Form Here: