Request for PPE Donations
Please double check your answers for errors!

We will do our best to check in with you regularly as your needs may shift during this crisis. Our goal is to keep our database of needs as up-to-date as possible to ensure the best coverage we can provide.

Note: Please add hospital and medical center addresses, or specific volunteer organization information, and with clear drop-off instructions for our volunteers.
Email address *
Which organization do you work for? *
Your Hospital, Clinic or Organization Name *
Your answer
Address *
Your answer
What do you need? *
Required
Will you take opened packages of unused supplies? *
Is there a "911" item that's completely run out? Are there items about to run out in 2-3 days? Please note both with quantities.
Your answer
Please provide # of workers and burn rate for the PPE most needed. For example, our 50 workers burn through about 100 KN95 masks in 2 weeks. The more details the more helpful to us in understanding your need.
Your answer
How will you accept donations? *
Required
Is there a minimum # of donations you'll take at one time? *
How should donation packages be labeled? (eg. PPE Donations, ATTN: John Smith, Head of Anesthesiology) *
Your answer
Drop-Off Instructions (eg. curbside procedure, loading dock description, who to speak to). Note: We will only take drop-off locations located away from ER or high-activity locations due to safety of our volunteers. Please give an idea of traffic activity at the dropoff point.
Your answer
Mailing Instructions (if available)
Your answer
Will anyone in the hospital be able to pick up donations from another location? If so, please mark what mile radius around the hospital this can happen
Your answer
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