Pittsburgh PPE: Donation Form
Once completed, you will receive an email with a copy of your donation form. Our team will reach out within 48 hours to start the process. We look forward to working with you!
Email *
Name *
Phone Number *
Address *
Note: This will ONLY be used to coordinate the donation pick up
What types of protective equipment (PPE) are you donating? *
Required
Surgical Masks vs Respirators (N95s)
If you are donating N95 respirators, how many?
If you are donating surgical masks, how many?
If you are donating gowns, how many?
If you are donating face shields, how many?
If you are donating gloves, how many?
If you chose "Other", what are you donating & how many?
Questions, comments or concerns?
A copy of your responses will be emailed to the address you provided.
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