Medical Facility Supply Request Form
Please fill this form so that your information and needs can reach suppliers who are able and willing to support you during this high demand period. Please select the closest quantity to your needs. Unite4India is only serving as a point of connection, we do not have the resources to verify supplies. It is the responsibility of the Hospitals and their purchasing managers to verify that the supplies fall under proper standards and approvals including but not limited to FDA 510K. We are not participating in any purchases or exchange of funds. We assume no liability for transactions, supplies or delivery. If you have financial ability to purchase the supplies please disclose on this form. If you do not have the financial ability to purchase the supplies we will look for donor support for you and help purchase the supplies for you.
Thank you for all that you do,