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About your duck

Please tell us about your child and their duck

Child's full name
Child's date of birth
Type of cancer
Date of diagnosis
Type of duck
  • Port
  • Hickman
Did you receive Huggable Hope for siblings? If yes, how many?
Sibling/s name & date of birth/s

Please note: not all the hospitals we supply Chemo Duck with are able to hold stock of Huggable Hope.  Please use the Additional Comments box below to request Huggable Hope/s for sibling/s.

Additional Comments


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