Pediatric Room Request

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Pediatric Room Request

Pediatric Room Request

Thank you for choosing Gift of Life Pediatric Transplant House as your ‘home away from home’ during your transplant journey. Gift of Life provides high quality, affordable accommodations to transplant patients and their caregivers in a supportive, home-like environment. Please complete the below form to make your room request for your upcoming stay. We will make every effort to ensure your request is fulfilled and in the unlikely event that a room is not available, we will assist you in making other arrangements for your accommodations.

Pediatric Room Request

Have you stayed at Gift of Life in the past?(Required)

Yes

If you answered no… STOP! All guests and caregivers are required to take an orientation tour prior to staying at Gift of Life Transplant House. Tours are scheduled, conducted in person and last 45-60 minutes. Please call 507-288-7470 to schedule a tour. At this time, your room request will not be honored.

Patient's First Name(Required)

Patient's Last Name(Required)

Type of Transplant(Required)

Requested Check-In Date(Required)

Estimated Number of Nights You'll Be Staying(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

What is the purpose of your stay?(Required)

Caregiver's First Name(Required)

Caregiver's Last Name(Required)

Caregiver's Relationship(Required)

Preferences?

Special Needs?