Face Mask Request Form for Health Care Professionals
If your healthcare organization is in dire need of fabric face masks, Volunteers of The Palm Beaches would like to do our best to help. Please fill out the form below and we'll be in touch as soon as possible.

***At this time we are only accepting requests from health care providers.**
Email address *
Name of healthcare facility *
Your answer
Contact Name:
Phone number *
Your answer
Address:
Your answer
Does your organization currently have access to face masks? *
Is your team members working directly with COVID-19 patients? *
What type of masks would be most beneficial to you?
How many masks is your team in immediate need of? *
Your answer
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