Required

Baby's NameYour baby's name or nickname, if any. (If left blank, "Our Baby" will display)

Date of lossMonth and Day, Year (Example: May 10, 2019)

DiagnosisThe fetal or maternal diagnosis that led to the decision to end your wanted pregnancy

MemorialLeave a few words or a poem to memorialize your baby

SignatureClose your memorial with a sign-off (optional)

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Photo by Boris Smokrovic on Unsplash