Wellness Pantry Donation Form

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Thank you for supporting The Nebraska Spoonie Initiative! We have some questions below regarding your donation. We currently are accepting items such as hygiene items, adaptive food/eating equipment, and adaptive hygiene tools.

Due to state legislation, we cannot accept Class II Medical Equipment such as; Syringes, catheters, prescription drugs, nebulizers, CPAP Machines, feeding tubes or liquid formulas. If you have such items, please consider donating to HELP (Health Equipment Loan Program).

We do not have the capacity to take on large adaptive equipment such as wheelchairs, scooters or commodes. Feel free to submit if you feel we may be able to accept your donation, otherwise please consider donating to Chrissy's Closet.

What are you donating? *

Hygiene Items (Deodorant, Toothpaste, Shampoo, Conditioner, Body Wash, Toilet Paper, Etc)

Adaptive Hygiene Items (No-Rinse Soaps, Briefs, Wipes, Allergen Safe/Silicone Free Items, Etc.)

Adaptive Hygiene Tools (Hygiene Aids, Straps/Cuffs, Etc)

Adaptive Eating Equipment (Straws, Silverware, Cups, Bowls, Cooking utensils, non-slip mats, cuffs, Etc)

Mobility Aids (Canes, Walkers/Rollator, Crutches, Etc)

Food (Powdered Formula, High-Protein Drinks, Food Thickeners, Etc)

Dressing Aids ( Zipper Pulls, Shoe Horns, Elastic Shoelaces, Adaptive Clothing, Etc)

Sexual Healthcare Items (Non-Prescription Birth Control, STI Prevention, Menstrual Products, Pregnancy Tests, Plan B, Lubes, Toys))

Other:

Required

Please describe the items you are donating and how much you intend on donating. *

Would you like to schedule a drop off, or a pickup for your donation? *

Pick up

Drop Off

Other:

Name *

What is the best way to contact you regarding your donation? *

Phone

Other:

Phone Number

Submit

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