Get Millie's Gift.

Bonding ultrasounds and compassionate support during a life limiting prenatal diagnosis.

Application to Get Help After a Life‑Limiting Prenatal Diagnosis

If you’ve received a life‑limiting prenatal diagnosis, we’re here to help you bond with your baby through bonding ultrasounds and emotional support. Start your application now.

Tell us a little about you. No medical records are needed to start. We will review your request, contact you within two business days, and coordinate with your care team.

What you will need

Your name and best contact
City and state, preferred language
Gestational age or due date
Diagnosis known or suspected
Your clinician’s name and clinic or hospital
Your consent for us to speak with your clinician

Important

We are not a medical provider and do not give medical advice. If you need immediate help, call your clinician or 911. Please do not upload medical records to this form. If records are needed we will provide a secure method.

Application to receive Millie's Gift

Step 1 of 3

Comments

This field is for validation purposes and should be left unchanged.

About you

Applicant Name(Required)

First Last

Your Email Address(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Mobile Phone(Required)

Provide your mobile phone number.

Best Time To Call You(Required)

When is the best time for us to reach you via telephone?

How did you learn about Millie's Gift?

About your pregnancy

Baby's Name or Initials

Please share your baby's name or initials if you have given them one.

Relationship to Baby(Required)

Mother

Father

Guardian

Other

Gestational age (number of weeks pregnant)(Required)

Due Date(Required)

Diagnosis (known or suspected)(Required)

You may write ‘life limiting condition suspected’ if testing is in progress.

Brief notes you wish to share (optional, 300 characters)

Where you receive care

Primary clinician name (MD, OB, MFM, midwife)(Required)

Please provide the name of your clinician that we may contact regarding the diagnosis.

Clinic or hospital name(Required)

Clinic or hospital City and State(Required)

City State

Clinician Phone #(Required)

Clinician Office Email (If known)