Mini Request

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? *only ages 2-17 please as we have limited supplies
child/recipient's gender?
Choose 4 favorite stuffed animals

Other
Choose 4 favorite colors

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 the color of AFOs or other medical items. If you do not have a device please put treatments options that are done. Photos are helpful, you can email them to medicalminisjoy@gmail.com or text (727) 355-5709
Why would you or your child benefit from a Medical Mini? (Aubrey loves reading everyone’s stories)
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)
If we run out of funds would you be willing to pay the $8-$10 for shipping?
How did you hear about Medical Minis?

Other
Policy & Disclaimer: Medical Minis may contain small components that could pose a choking hazard. Many of the included medical items are removable to allow children to safely explore and learn. No needles or sharp objects are used in any Medical Minis products. By accepting a Medical Mini, you agree to release Medical Minis, Inc., its supply donors, and all volunteers from liability for any injury that may occur after the product has been delivered.
Should be Empty:

Mini Questionnaire