#GetUsPPE LA - Request Form
We are working on coordinating donation of N-95 respirators and other PPE to local healthcare facilities. Our plan is to have volunteer drivers pick up PPE from outside peoples doors and deliver them where they are needed.

If you are a healthcare facility (or healthcare worker) in need of PPE, please complete the form below and someone on our team will get back to you soon.

Other questions/comments? Email us at getusppela@gmail.com
Point of contact: Name *
Point of contact: Title *
Point of contact: Phone number *
Point of contact: Email Address *
Preferred method of contact? *
Facility Name *
Facility street name and number (e.g. 123 Health Street) *
City *
Zip Code *
Are you able to accept FDA approved KN95 standard respirators?
Clear selection
What PPE is there a shortage of? *
Amount of PPE needed for the above? *
E.g. N95 (20), face shields (50), gloves (10), if known
Current supply? *
Are you able to accept opened but unused supplies? *
Instructions for donation drop-off
Anything else we should know?
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