Facilities for Notes for Support
Finding the names of hospitals that have COVID-19 cases & getting in touch with them is incredibly time-consuming on our end. If you know a hospital that has confirmed that they want our notes, please send them our way!
Sign in to Google to save your progress. Learn more
Did you confirm that the hospital would like to receive these notes? If so, how? *
E.g. "Yes, I talked to...", "Yes, I'm a hospital manager..."
Your contact at the hospital *
Please provide a name and number/email.
Name of Hospital / Facility *
Mailing Address *
How many notes would you like to receive?
You can choose to receive notes for COVID-19 healthcare workers and/or patients.
For Healthcare Workers *
(If none needed for healthcare workers, please type 0)
For Patients *
(If none needed for patients, please type 0)
Optional: Any comments?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy