HAND of the Bay Area - Peer Support Request Form
Complete this form to be matched with a volunteer for one-on-one support. To register for support groups, please email meetings@handsupport.org
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Email *
Name *
Phone Number
Mailing Address
City/State/Zip
Please briefly describe your experience with pregnancy/infant loss.
If you have experienced a pregnancy/infant loss, please provide the date(s) of your loss(es) and name of baby/babies (if named).
Do you have other children?
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If yes, names and ages.
Have you attended a HAND support group?
(Support group attendance is not required to receive peer support)  
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If so, which chapter?
What topics or concerns would you like to discuss with your peer support volunteer?
Do you have any special concerns you would like your peer support volunteer to know about?
How would you like to communicate with your peer support volunteer?
If you are new to HAND, would you like to be added to our email list to receive our quarterly newsletter and occasional notifications about HAND activities?
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Submit
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