Request a wish for someone that has been diagnosed with a terminal illness aged between 18 and 55 years

How to request a wish

When a person is diagnosed with a terminal illness, there never seems to be enough time or money in the world to achieve any of the individuals wishes. Family and friends will go out of their way to make every moment they have left as memorable as possible.

We want to help with that by granting a wish for people experiencing something awful in the prime of their lives. All we hope is that we can help make something special happen by granting them a day out(sometimes a night), remembrance gifts for the family, a trip to the theatre, and many other memorable things they might wish for.

All you have to do is complete this simple application form with your details, including any accompanying adult.

You will have to ask a medical professional to complete a couple of sections i.e. nurse, GP, registrar, or consultant who is familiar with your condition.

If you are getting in touch with us from a hospice, NHS foundation trust, or similar please contact us directly by calling: 07388 514837.

Are you eligible?

Before completing this form, please consider the below points to see whether or not you are eligible for our wishes:

  • Are aged 18 to 55
  • Resident in the UK
  • Not already had a wish granted by Purple Heart Wishes or any other wish granting charity based in the UK - To enable us to grant more wishes for those who apply, we are only able to grant one wish per person.
  • Receiving treatment for a terminal illness* on the date we receive your application.
    * This includes, but is not limited to cancer, motor neurone disease, cystic fibrosis & Huntington’s disease. Terminal illness may also include those in palliative care, those in advanced stages of progressive degenerative conditions, severe muscle wasting diseases, neurological diseases & organ failure.

Whilst we will always strive to fulfil the request of every eligible applicant, the number of wishes we are able to grant at any one time is limited. Therefore eligibility does not guarantee that we will be able to arrange a wish.

Once you have completed your application, please scan or photograph the forms and email to:

If you do not have access to email or you want to talk to us about your application, please do not hesitate to contact a member of the team on: 07388 514837.

Purple Heart Wishes is a small charity that relies 100% on wonderful fundraisers and donations.

To provide wishes, we must be cautious about how we spend our funds, therefore we cannot guarantee granting a wish during peak holiday periods.  Our aim is to work with, and support you, to find a solution to ensure lifelong memories are made.

We will endeavour to do everything we can to grant a wish for you exactly how you want it to be.  However, this may not always be possible and out of our control.


Download the wish request form