Contact S3Kit — Tracheostomy Gift Baskets

reach out

Fill out the form below to send or receive a complimentary gift basket or email us at hello@s3kit.org to request more information.

Currently, we are shipping anywhere in the contiguous United States.

Name

First Name

Last Name

Is the child a girl or a boy?

Girl

Boy

How old is the child?

Please indicate years or months. For example, 4Y for 4 years old or 4M for 4 months old.

When is the expected discharge date of the child?

Ideally, we like to give families/caregivers the basket within a few weeks of the child's discharge date.

YYYY

What is the address the basket will be sent to?

If the address is a hospital, what is the name of the hospital? What unit should the basket be sent to?

What is the contact name for the address?

Do you want the family/caregiver to know you requested the basket?

Yes

Is English the primary language spoken in the home? If not, what is the primary language?

Anything else you want us to know?