Please briefly describe your experience with pregnancy/infant loss.
Your answer
If you have experienced a pregnancy/infant loss, please provide the date(s) of your loss(es) and name of baby/babies (if named).
Your answer
Do you have other children?
Clear selection
If yes, names and ages.
Your answer
Have you attended a HAND support group?
(Support group attendance is not required to receive peer support)
Clear selection
What topics or concerns would you like to discuss with your peer support volunteer?
Your answer
Do you have any special concerns you would like your peer support volunteer to know about?
Your answer
How would you like to communicate with your peer support volunteer?
If you are new to HAND, would you like to be added to our email list to receive our quarterly newsletter and occasional notifications about HAND activities?