Wish Request Form
Request a wish
Ambulance Wish Western Australia enable people receiving palliative care or who are terminally ill to fulfil a final wish by visiting a place of personal significance, for example, to admire their own garden, to feel the breeze of the beach or to be surrounded by their loved ones and pets.
Medically trained volunteers and adapted ambulances provide the means to make these last dreams come true.
To request a wish please complete the below full to the best of your knowledge. On successful submission, you should receive a copy of the submitted form. Alternatively, complete a downloadable form and email it to Ambulance Wish Western Australia.