Doll Hospital Admission Form - Wisconsin
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1DOLL HOSPITAL ADMISSION FORM
Where your American Girl doll goes to get better!
®
Please allow two to three weeks for repairs.
To learn more about our Doll Hospital, visit .
Today, ____ /____ /____ , we’re admitting _______________________________ .
(Date)
(Your doll’s name or type)
Her guardian is _______________________ , who was born on ____ /____ /____ .
(Girl's name)
(Birth date)
After being repaired, your doll will return home with:
Certificate of Good Health • Doll Hospital Gown • Doll Hospital ID Bracelet • Get-Well Balloon
With Bitty Baby/Twins repairs, ID bracelet and balloon are not included.
Type of repair:
Admission form
18" AMERICAN GIRL DOLLS
Bill to:
Total price
$24
Reattachment of head or limbs
Name
$24
Eye replacement
(same eye color only)
Address
$39
New head
(same American Girl only)
$39
New body
(torso and limbs)
City
State
Zip
$29
New limbs or torso
(circle one)
Home telephone (
)
$24
Wellness visit
Skin cleaned, hair brushed, gown, certificate,
bracelet, and balloon, but no "major surgery"
E-mail address
BITTY BABY & BITTY TWINS
Items will be shipped to address above unless an alternate address is given below.
$14
Reattachment of head
$14
Ship to:
Eye replacement
(same eye color only)
New head
$19
(same Bitty Baby or Bitty Twin only)
Name
New body
$19
(torso and limbs)
Address
$14
Wellness visit
Skin cleaned, hair brushed, hospital gown,
and certificate, but no "major surgery"
City
State
Zip
$6.95 per doll
Shipping & processing
For US and its possessions.
Call for international rates.
Comments:
RUSH RETURN SHIPPING OPTIONS
Most Doll Hospital stays last two to three weeks. If, upon release,
you would like your doll returned via RUSH service, please select
from the options below and check the box on the mailing label.
2-Day, add $10
Next Day, add $15
Subtotal
Sales Tax
Gift certifi cate no.:
We are required to collect applicable sales tax for deliveries
to the following states: CA, GA, IL, NY, TX, and WI.
Total
May doctors replace additional parts on your doll, if needed during surgery, at no additional charge?
Yes______
No______
Important information about your repair:
• All replacements & attachments include skin-cleaning & hair-brushing at no additional charge.
• Wellness Visit skin-cleaning will remove most surface dirt from your doll’s vinyl, but is not likely to remove ink or dye stains.
• Wellness Visit hair-brushing will improve the appearance of the doll’s hair, but will not make a well-played-with doll’s hair look brand-new.
• Admission of a complete doll (head and body) is required to purchase a new head or body.
• Parts replaced through surgery will not be returned.
Payment method:
Invoice will be mailed to purchaser as order
Doll Hospital Admission Process
confirmation. Enclose your personal check, money order, gift certificate, or
credit card information as indicated below.
Place your undressed doll and admission form with payment
Make checks payable to American Girl.
attached, including shipping charges, in a sturdy box. Please
Check/money order
MasterCard
do not wrap your doll in newsprint. If sending more than one
(16 digits)
Gift certificate
Discover/Novus
(16 digits)
doll, please complete a separate admission form for each
American Express
Visa
(15 digits)
(16 digits)
one. Clip and tape the mailing label (at right) to your package
to send your doll to the hospital via UPS or insured mail.
Credit card number
Rush shipping is available, except for APO/FPO addresses;
details listed above.
–
CID number
Expiration date
For more information, call 800-845-0005.
Month
Year
W 0408
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Parent category: Medical