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Anencephaly Network

 

Have you received the diagnosis of anencephaly for your baby?
Are you searching for other parents who have experienced what you are now feeling?
Would you like more exchange than the reading of personal stories?
Do you want to correspond with other parents who have experienced what you are facing?

OR

Have you given birth to a baby with anencephaly?
Are you willing to share your experiences with others through a personal relationship?

Join the "anencephaly-network" and we will do our best to put you in touch with other parents who live as close to you as possible.

Please take a few moments to fill out the following form. You can be absolutely sure that we will never provide your information to anyone else, so you can be assured of complete privacy.

Due to lack of time (all the work on this site is done on a volontary basis) we have to limit the participation to this network for parents who choose to carry to term only. Thank you for your comprehension.

 

All fields with * must be completed, please move from field to field with the tab-key of your keyboard and not with the mouse.

 

Your address

your full name * :
street / postal address * :
town * :
zip code * :
state / region * :
country * :
phone number:
e-mail * :

Your baby

name of your baby * :
baby's sex * :
week of diagnosis * :
due date, if you are still pregnant:
at how many weeks of pregnancy was your baby born * :
was the birth induced * :
your baby's birthday:
your baby's length of life after birth * :
year of birth of your other children :
what else would you like to share:

Agreement

I agree that my details can be forwarded to other parents of the anencephaly network

 

 

Last updated July 9, 2012

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