CFR SUIDI Doll Request Form

Thank you for your commitment to improve death scene investigations in your community. You are receiving the enclosed Sudden Unexpected Infant Death Investigation (SUIDI) Doll. Use of the doll will enhance your infant death scene re-enactments and witness/caregiver interviews, particularly when used in conjunction with video-taping procedures. This doll should be used for any unexpected and/or unexplained infant deaths to have the witness(es) describe and re-create the infant's location and/or body position for you. This doll is a non-descript, featureless tool intended to help reduce the anxiety that many caregivers may feel when discussing the loss of their infant.

To request a doll, please complete & submit the form below:

Name (required)

Agency (required)

Title (required)

County (required)

Phone Number (required)

Email address (required)

Confirm email address (required)

Have you previously received a SUIDI doll?

Yes

How many SUIDI dolls are you requesting? (required)

How many SUIDI dolls have you previously received? (required)

Date (required)

Mailing address (No PO Box)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

CFR SUIDI Doll Request Form

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