Cuddle Cot Request Form

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Unfortunately, not every hospital/facility has a Cuddle Cot. Request that a Cuddle Cot be donated to a hospital/facility in need of support to allow their grieving families more time to make memories with their baby. SAILS partners with various healthcare facilities to provide the Cuddle Cot to their patients.

Email *

Full Name *

Email Address: *

Name of provider/hospital/facility: *

Address of provider/hospital/facility: *

Point of Contact at provider/hospital/facility: *

How did you learn about us? *

Website

Family/friend

Newsletter

Online Search

Social Media

Healthcare Provider

Nonprofit Organization

Community Event

Other

Do you currently have a bereavement committee, program or dedicated staff person?

Yes

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Would you like to receive newsletters, event information and resources from SAILS via email? *

Yes, please.

No, thank you.

I already receive SAILS mail

I authorize a Stillborn and Infant Loss Support (SAILS) staff member to follow up with me, if needed, for further information. *

I Agree

Send me a copy of my responses.

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