Hanscom Park COVID-19 Care: What are your needs? ¿Qué necesita?
*espanol abajo

This form is to gather information from folks whose immune systems are compromised and need support during this time.


Este formulario es para recopilar información de personas cuyos sistemas inmunes están comprometidos y necesitan apoyo durante este tiempo.
Name / Nombre
*this does not have to be your legal or full name. include your pronouns if you'd like!
What do you need? ¿Qué necesita?
Clear selection
How should we contact you? ¿Cómo le podemos contactar?
Clear selection
Address - Dirección de casa
*this will not be shared publicly *este no sera compartido publicamente
Phone number - Número de teléfono
*this will not be shared publicly *este no sera compartido publicamente
Email address - Correo electrónico
How urgently do you need it? ¿Qué tan urgente es su necesidad?
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