Telephone Number
01244 362226
or
[email protected]
Home
About Us
Become a Donor
Memory Milk Gift
Receive Milk
Healthcare Professionals
Research and Development
Partners
Home
›
Request a Collection
Request a Collection
Please complete this form to request a collection and we will be in touch to arrange. Please complete your temperature sheet and checklist to give to the driver.
Name
Email address
Number of bottles to collect
Earliest date milk expressed
Do you need more bottles?
*
Yes
No
Do you need a new temperature sheet?
*
Yes
No
Please indicate your availability by ticking suitable days for a collection
*
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Thursday AM
Thursday PM
Friday AM
Friday PM
Comments