Breast Pump Feedback
 The Alliance for Black NICU Families™ relies on grants to purchase pumps like the one you received.  If you would take a simple survey as a form of a thank you, we will be able to report that to the funders, to future funders and more.  

Think of it as paying it forward to another NICU parent.  Thank you! 
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ALLIANCE FOR BLACK NICU FAMILIES - Breast Pump Program Feedback
Name: *
Email Address: *
Phone number: *
May we text you at the above phone number? *
Name of your NICU: *
Please let us know how getting access to this pump helped you and your family.  Say as much as you wish. 
 *
Which breast pump model did you receive? *
If you chose "other" please provide the model name:
How happy are you with your personal breast pump? *
If not satisfied with product, please explain:
 Please confirm that we may use this for further fundraising efforts and reporting to funders as well as encouraging others to donate on our website, social media, digital/printed materials.  
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How would you like us to list your name? *
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