Requests for PPE From Masks4Medicine
What is the name of the healthcare facility this PPE donation is for? (Please know that we are prioritizing NYC facilities and nearby areas for now, but as we grow in supply, we will be sure to reach out to you if located elsewhere!) *
Your answer
What department are you from? *
If other healthcare role, please describe. OR if you are not a healthcare delivery facility, what is the mission of your organization?
Your answer
What is your role? *
If other, please describe
Your answer
What is your name?
Your answer
Your phone number (cell phone is preferable for texting) *
Your answer
Your email address
Your answer
Is this PPE for direct COVID-19 patient care?
How many N95s do you need?
Your answer
How many surgical masks do you need?
Your answer
How many fabric masks do you need?
Your answer
Are you looking for other PPE supplies (gloves, gowns, face shields, etc?) Please indicate type and amount needed.
Your answer
Other information you'd like to provide
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