Next Step Kit Request Form

Hydrocephalus Next Step Kit Request
Before You Begin Please confirm this request is for someone

Your Information

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Name
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Mailing Information:

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Address
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Patient Information

Patient's Name
Patient's Name
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Support the Hydrocephalus Next Step Kit

photo miaOur Next Steps Kits are provided free to families navigating a new hydrocephalus diagnosis, and your generosity helps make that possible.

Your gift helps us put trusted resources—and a comforting Hydro Bear—into the hands of families when they need them most. Every gift, no matter the size, makes a difference.

$15 helps deliver a Next Steps Kit to a family
$30 provides a Hydro Bear
$45 provides a Hydro Bear and helps deliver the kit to a family

Thank you for helping us be there for families from the very beginning.

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