Pregnancy & Infant Loss Registration Form

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Welcome to the Hearts2Heal 6-week Pregnancy & Infant Loss Support Group.

This program is designed to provide a safe and compassionate space for individuals who have experienced the profound loss of a pregnancy or infant. No matter the circumstances. Our aim is to offer emotional support, coping strategies, and a sense of community during this challenging time.

Please use this form to register for the Fall 2023 cohort dates. The Fall cohort will take place in-person, in Austin, TX. Location will be provided by end of September.

If you have any questions or concerns, please send an email to info@hearts2heal.org

First Name *

Last Name *

Age *

Are you able to attend all 6 sessions from 6:30pm-8:00pm?

October 5,12,19,26

November 2,9

Yes

I'll do my best

How did you hear about the Hearts2Heal Pregnancy & Infant Loss Grief Support Group?

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