Congratulations, You’re Trach Free! Welcome to the Naked Neck Club.

Let’s Celebrate!

Decannulation is a monumental milestone and a call for major celebration. We invite you to join the Naked Neck Club (NNC) to commemorate this incredible accomplishment so we can recognize all you have achieved while on service with Pediatric Home Service and celebrate alongside you! As a Naked Neck Club member you will receive a commemorative PHS NNC Case to store everything that reminds you of the achievements you made to achieve life trach free – just fill out the form below. We’ll also make sure you receive our quarterly newsletter and any other communications we think you’d be interested in.

*Required

Date of Decannulation*

Patient Name*

First Last

Parent Name

First Last

Address*

Street Address City State ZIP Code

Email Address*

Anything you’d like to say or share about your time with PHS?

Would you be interested in sharing your/your child’s story?

Yes

No

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*No longer want to be part of the Naked Neck Club? Click here to let us know and we’ll be happy to remove you/your child.