Mini Questionnaire
Questions about the child to help customize their mini
What is the child/recipient's name? *PLEASE ONLY REQUEST FOR YOURSELF OR YOUR CHILD, we do not take friend requests
What is the child/recipient's age? *not recommended for children who put toys in their mouths and due to limited supplies not accepting requests for ages 18+
Choose 4 of their favorite stuffed animals
Teddy Bear
Unicorn
Monkey
Dinosaur
Bunny
Dog
Sloth
Mickey Mouse
Minnie Mouse
Star Wars
Other
Choose 4 of their favorite colors
Red
Blue
Orange
Yellow
Purple
Black
Green
Pink
White
Colorful Animal
Classic Animal
Other
What medical conditions and/or devices do they have? *There are some conditions we may not be able to reflect; please let us know if surgical feeding tubes are danglers or buttons. Please include color of AFOs or other medical items
Any additional information about their likes, interests, or illness that would help their mini best relfect them
Email address so we can contact you regarding the mini
*
Address you want the mini mailed to (only shipping within the USA at this time, PLEASE READ BELOW REGARDING SHIPPING)
*
We often run out of funds to pay for shipping, if this happens would you be willing to pay the $8-$10 for shipping?
Yes
Maybe
No, wait for more donations
How did you hear about Medical Minis?
Instragram
Facebook
Friend
News
Other
Policy & Disclaimer: Medical Minis may contain small pieces that can be choking hazards. Many medical supplies used in the minis can be removed/taken out so that children can see and learn about them. No needles nor sharp objects are used in any minis. Do you agree to release Medical Minis, Inc, supply donors, and all volunteers from any possible injury that may occur once the mini is received?
*
Yes
No
Submit
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