Inspiration Kit Request Form
If you're a nurse, sign up here to receive an Inspiration Kit for FREE!
Each Inspiration Kit varies and can include anything from self-care items, a mug or tumbler, to a Nurses Inspire Nurses tee. What every kit does include is a thank you note, mantra card, and a whole lot of love!

Inspire A Nurse is only for nurses. We ask that if you are not a nurse you do not continue with this process.
We want to make sure our resources are directed to those in the nursing community. Please complete the form only once.

For any questions or to read our FAQs, please visit

Please note you will receive a confirmation email when your Inspiration Kit ships!
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address - By giving my email I am authorizing Nurses Inspire Nurses to send me an email confirmation when my Inspiration Kit ships. *
Do you give Nurses Inspire Nurses permission to ship to your mailing address? In order to receive an Inspiration Kit in the mail we do require your address. Due to volume we are only allowing participants in the US at this time. *
Street Address *
Apartment or unit number if applicable
City *
State *
Zip Code *
Country *
What type of nurse are you? Let us know what unit you work on! *
What is your unisex t-shirt size? *
I have an interest in ongoing support. I authorize a member of the Nurses Inspire Nurses team to email me about upcoming opportunities for support and connection. *
Thank you for the hard work you do every single day!
Clear form
Never submit passwords through Google Forms.
This form was created inside of Nine Lives Health & Mind. Report Abuse