Donating Tech: TeleHealth for Seniors
Please provide any camera-enabled smart devices you have at home. Old chargers would also be helpful. If you wipe / reset your device to factory settings, all of your information will be deleted and it will be safe for others to use.

By providing seniors (who are often on subsidized health insurance) with video-enabled devices, they will be able to take advantage of free wifi hotspots with Spectrum, or use the wifi outside of doctors' offices to conduct their doctors' appointments. We can provide seniors with guidance on how to set up an email and account for telehealth!

Please fill out this form to give tech!

ALL DEVICES MUST BE CHARGED, RESET, AND WIPED DOWN ACCORDING TO CDC PROTOCOL.

(TeleHealth Access for Seniors is a non-profit registered in Florida. We are 501(c)(3) nonprofit pending. Your donations are not tax-deductible yet).
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
Which devices can you give? *
Required
How many of the selected devices can you give? *
Your answer
Do you have accompanying chargers you can give as well? (We accept cords and blocks.) *
Required
Please check which requirements you can meet. We can only accept devices that meet all three. *
Required
Please select which region you are located in / closest to. Our volunteers and medical providers are located in these regions. If you are not in any of these regions, please click other.
Can you ship your devices to us? We will email you with more information on where to send your devices. *
If you cannot ship, what is your address? We will do our best to have a volunteer in your area contact you and pick up these devices from a safe distance.
Your answer
How did you hear about us? Please mention if a specific volunteer in your area directed you to our form in the "Other" category.
Submit
Never submit passwords through Google Forms.
This form was created inside of Yale University. Report Abuse