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Praying4MyPreemie Order Form (Preemie Poetry)
The birth of a preemie child is an amazing experience, filled with emotions that are often hard for parents to express. Joy, sadness, triumph and fear - the beautiful journey through prematurity should be captured and shared with the world. What better way to do that, than with POETRY!

Kaleena Berryman

Thank you for choosing Praying4MyPreemie to help celebrate your child! With your guidance, we will create a “one of a kind, detailed and just for your child” poem, to celebrate their journey, birthday, a milestone, coming home date – it’s all up to you! You can also honor Mom, Dad, Grandparents, favorite nurse etc., just tell us all we need to know in your answers to the questions below.

Please complete this order form and return it to us as soon as possible. Here is an outline of the process:

1. Complete form and return to Praying4MyPreemie @
2. Within 24 hours you will receive confirmation of your order form, and payment will be requested.
3. Payment of $50.00 for a tailored poem or $75.00 for an original poem  must be made before the writing process begins. Writing a poem takes a great deal of time and thought. DISCOUNT CODES CAN BE APPLIED BELOW
4. After payment is received, an email confirmation will be sent to you. At that time, you will submit five pictures to accompany your poem.  That begins the SEVEN business days countdown to complete the work. (Does not include weekends).
5. After a draft is sent, you can make revision requests, free of charge. Our goal 100% satisfaction, and to represent your child in the most accurate way possible.
6. The final poem will be sent to you in three formats, PowerPoint, PDF and JPEG.
7. There are no refunds once work on the poem begins, unless it is not completed.
8. Please be advised that Poetically Yours will maintain the copyright of the poem. However we encourage you to share it and use it to your discretion. We can also provide framing of the poem for an additional cost.
9. Poetically Yours will not share the poem on our blog without your permission.

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Sample - Tailored Poem (On the Day You Were Born) $40.00
Sample - Tailored Poem (On the Day You Were Born) $40.00
Sample - Original Poem (Title Determined by your Story) $75.00
Answer the Questions below to order your poem! If the poem is to honor Dad, Mom, Nurse or etc., make sure to focus a part of each answer on that person. Feel free to add more important info in the "what else" section. Thank you!
Your Name:
Your Child’s Name:
Name of Child’s Other Parent:
Your Email:
Your Relationship to Other Parent:
Child’s Birthdate:
Do you want a tailored version of "On the Day You Were Born" or an Original Poem
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Discount Code
Gift Certificate? Gift Certificate will be sent to you. Once the person redeems, we will send them the order form.
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What Hospital was your child born in?
Your City, State:
Your Child’s Due date:
How Many Weeks Early Was Your Child and What Was Their Birth Weight?
What is Your Child’s Current Age?
Tell me about your child’s birth:
Tell me about your child’s NICU stay:
Are there any fond memories that stand out? Songs you sang? Moments you want included?
How is your child doing now?
Optional: What do you want the theme of the poem to be? Are we celebrating a milestone like birthday or baby coming home? Is there something about your child’s spirit or your journey that you want to be the heart of the poem?
What are your wishes for your child?
Is there anything else you want us to know?
Does your child have any siblings? Best friends or close cousins you want included?
Payment can be made two ways: A. Via Paypal – OR B. Via Mail
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