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Time to Heal Interest Form

The Time to Heal group is a private group especially for mothers who have made the difficult decision to terminate a pregnancy for medical reasons.  The group meets in a private, closed online setting.  In order to join, please complete the following information so that we can learn more about your loss.  One of us will be in touch soon with more information on the online group.
1.Your email address
2.Your name
3.Street name and number (mailing address)
4.City and state of residence
5.Your best contact number
6.Did you have to make the painful decision to terminate your pregnancy due to medical reasons?
7.What diagnosis does/ did your baby have?
8.Are you currently pregnant or have you already experienced your loss?
9.How did you hear about the H.E.A.R.T.strings Program?
10.Would you like to receive a care package in the mail?