Thank you for your generosity as we work towards procuring personal protective equipment (PPE) for our frontline healthcare providers. If you are able to donate any of the following medical supplies (NIOSH N-95 respirators, plastic face shields, surgical masks, other masks and respirators, surgical gowns, bunny suits/coveralls, surgical caps, gloves, reusable non-ventilated goggles, Sani-cloth purple/red/bleach wipes, Cavicide spray/wipes, Clorox/Lysol/Bleach disinfectant wipes, or alcohol-based hand sanitizer), please fill out this donation form.
Once we receive your completed form, one of our volunteers will reach out to you to coordinate a pickup/drop off time and location.
Email firstname.lastname@example.org should you have any questions or concerns after completion of this form.
Please note: All of your information will be strictly confidential and is only used internally to coordinate your donation and send you a thank you note.