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Perinatal Loss Comfort Box Order Form 

The United By Loss Foundation will provide complimentary comfort boxes to all mothers and birth givers who have experienced perinatal loss in 2022-2023. We want to support you! You can pre-order your comfort box through our website. The comfort boxes include a copy of The Power of Healing: A Memoir of Loss and Victory, a healing journal, an aromatherapy candle, an aromatherapy shower steamer, a keepsake bracelet, prayer cards, A Mother's Grief brochure, and much more! The comfort boxes have been created for moms by moms.


Orders are accepted monthly for shipment the following month. For example, an order request made in July will be delivered in August. As we move forward with the development of our comfort boxes, we may alter or include more perinatal loss resources that are relevant. The order form may undergo further revisions soon.


Each mom is permitted only one comfort box. Please email if you have any questions or concerns, require assistance with the form, or would like to request more than the permitted number of comfort boxes for an event. 


 Must be a Georgia resident.

Must have experienced perinatal loss, which includes early loss (before 20 weeks), stillbirth, or neonatal loss (newborn through 28 days of life). 

The loss must have occurred between 2022-2023. 

Permitted only one comfort box. Please pay $25 for shipping and packaging expenses. Payments can be made via the donation page. 

Order Form


Street Address*



Zip/Postal Code*

Email Address*


Date of Loss*

Baby's Gender*

Type of Perinatal Loss*

Select an option

Consent Statement *

Please share additional information about your loss. *

How did you hear about us?*

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