21-22 Weeker Survey
This form is being used to verify hospitals that have saved 21-22 weekers in the past. Your identifying personal information will be kept completely confidential.
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First Name *
Last Name *
Best contact phone number (please include area code): *
Best contact email address: *
At what gestational age was your baby born? *
What was the approximate weight of your baby at birth? *
What month was your baby born? *
What year was your baby born? *
What is the name of the hospital where your baby was saved? *
What city is the hospital located in? *
What state (or province) is the hospital located in? *
Do you remember the name of the doctor(s) who agreed to save your baby? If so, please provide name(s). *
If you are adding a hospital based on written policy, a verified news article, or other direct evidence of providing active medical intervention BEFORE 23 weeks please post below:
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