Print Request Form

A gift bag with a stuffed animal and a bottle of water.

At HCU Network America, we believe that one of the most important steps to empowering patients and caregivers is giving them the support and tools needed to succeed! We know that a diagnosis can be overwhelming and riddled with concerns and questions. To us, one way to combat those feelings, and give you the confidence you need, is by providing you with one-on-one support, educational resources, and practical tools, such as scales, cooler bags, and more! Our request for a kit survey allows you the opportunity to request a one-on-one introductory call (with more opportunities to connect), and then a customized kit to the patient's needs. Don't want a call or a Zoom? That's fine too - we are happy to send you the customized kit.

You can also use this form to request copies, without requesting a full kit.

*Kits can only be sent to patients in the continental US. However, we are happy to connect virtually and share the educational materials with you via weblinks!


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