Facility Sample Kit Form
Request to receive a sample Held in Hope miscarriage kit to review
What is a Held in Hope Kit?
The Held in Hope Kit is a first-trimester miscarriage support kit designed to equip women experiencing pregnancy loss at home. Each kit includes practical supplies, step-by-step guidance, and resources to help women navigate the physical and emotional aspects of miscarriage. ** Please note: This is not a traditional care package or sympathy gift. Our kits are specifically designed to provide practical support during the miscarriage process. To learn more about what is included and how our kits are used, please visit www.heldinhope.org.
Customer Details:
Full Name
*
First Name
Last Name
Business Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Kit to Review
Facility request kits will ship within one week of submitting the form. Once received, we encourage you to take time to review the kit and share it with your care team. Please don’t hesitate to reach out with any questions. We look forward to working with you to better support women through pregnancy loss.
I am requesting to receive a Held in Hope miscarriage kit to review
*
Yes
Introductory Set of 4
We want providers to feel confident and familiar with the Held in Hope Kit before offering it to patients. We encourage you to keep one kit to review and reference with your care team, and reserve the remaining three kits for patients experiencing pregnancy loss. This initial set of four kits is provided at no cost as a one-time introductory offer to help your facility begin offering Held in Hope Kits to patients in need.
I am requesting to receive a set of 4 Held in Hope miscarriage kits to start using with my patients
*
Yes
No
Kits come in three options. Please select which options we should include in your introductory set.
Light skin tone
Dark skin tone
Spanish
All three options
Get in touch
Please do not hesitate to email Info@heldinhope.org with any questions. We are also happy to set up a call or zoom meeting. To order additional Held in Hope kits please visit www.heldinhope.com/shop
At this time, Held in Hope Kits are available for shipping within the United States only.
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