Three Little Birds Professional Provider Membership Program Registration

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Three Little Birds is equally committed to serving perinatal loss families and the professional providers that walk alongside them in the Philadelphia/South Jersey metro region. Our free membership program will add your name to our distribution list with quarterly communications with information on our services, programs, medical abstracts and research in perinatal health, information we have tracked on legislature governing healthcare procedures and reporting requirement, special discounts and giveaways that promote self-care and more!

Death work is collaborative, not competitive. Even if you have an established bereavement program, Three Little Birds can provide a significant added value in helping standardize perinatal bereavement care, encourage families to bond and make memories as well as the support they can find through peer connections, groups and events post-partum. We have several partnerships with mental health professionals and postpartum providers with personal and professional experience with perinatal loss that support our families at no cost to them.

The first email will be issued in January 2024. Please add threelittlebirdsperinatal@gmail.com to your white/safe list of emails so you don't miss it!

Email *

First and last name
*

Telephone number that we can text:
*

Employer name and location
*

Years experience
*

Select which applies:
*

Perinatal/Neonatal Physician

Perinatal/Neonatal Nurse

Maternal Fetal Medicine Provider

Mental Health Professional/Licensed Counselor

Social Worker

Sonographer/Ultrasound Technician

Emergency Room/Family Physician

Funeral Service provider

Other:

Required

Explain your experience related to miscarriage, stillbirth, neonatal loss as a provider
*

Please select your interests in our membership program (select all that apply)
*

Perinatal Bereavement Training

Access to bereavement doulas to come bedside to support patients and staff

Access to updated and vetted resources locally and beyond (including financial resources, disposition providers and mental health support)

Support in developing a Perinatal Palliative Care Program

Three Little Birds information to provide to families

Perinatal Bereavement Info Sessions for staff (including cultural competency, photography skills, support group facilitation, etc)

Assistance with post-partum follow ups with patients

Communication scripts on how to relay dispostion/autopsy options and how to offset those financial burdens

Ways to volunteer and be an ambassador for perinatal bereavement support for patients and staff

Other:

Required

I am interested in a free perinatal bereavement needs assessment for my employer/office/etc.

As a testament to our commitment to supporting families and providers through perinatal loss, Three Little Birds will provide you with a free perinatal bereavement needs assessment of your facility and staff. This includes an on-site visit to assess support items, review of processes and resources and brief interviews staff with their experience and needs and a report and proposal on how we can provide value to your organization, maintain standards set by recent legislature and find simple solutions to common problems.

Yes

Possibly

Not at this time

N/A

What are some common struggles or questions your patients have when experiencing perinatal loss?

What are some questions you may have regarding Three Little Birds services or programs?

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