SunCloud® Returned Cushion Request

Print or fill in, then email a photo/scan to support@pelvicpainsolutions.com.

Applicant Information

Request Details

Agreement

  • Cushions are donated on a first-come, first-served basis while supplies last.
  • All cushions are cleaned and inspected before redistribution.
  • Availability is not guaranteed, and shipment timelines may vary.

Optional Consent

For SunCloud® Office Use Only

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