Transplant Families Contact Form

The Children’s Organ Transplant Association is pleased to provide information to you. Please complete this form and click send. A member of our staff will answer your inquiry as soon as possible.

*Required information

First Name: *
Last Name: *
Relationship to Transplant Patient: *
Address: *
City: *
State: *
Zip Code: *
Email: *
Phone: *
Transplant Patient's Name: *
Type of Transplant:
Awating Transplant:
Transplant Center:
How did you learn about COTA? *: Social Worker at the Hospital
Staff Member at the Hospital
Referred by another Transplant Family
Another Organization
Web Search
Other
Comment or Request:

COTA video plays here.

Rebecca Bathon

Giving Hope:

“Upon hearing Amber’s diagnosis, we were devastated. But after we heard about COTA, I started to relax. With COTA’s support, we were able to keep our home while we were away at transplant. Suddenly I knew there was hope for our future; I didn’t need to fear my entire world falling apart. With COTA, I knew we could make it through.”

COTA

GIVE HOPE

MAKE A MIRACLE

Transplant Families Contact Form

Giving Hope:

Christy Battazzo