N95/KN95 Face Mask Request Form

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Thanks to support from Maine Department of Health and Human Services, Healthy Acadia has a limited* number of N95/KN95 NIOSH-certified face masks available to help reduce the spread of COVID-19. Upon request, Washington and Hancock County residents may request four (4) face masks per person by completing and submitting this form. Your masks will be mailed to you by U.S.postal mail. Please provide your complete shipping address below to ensure proper delivery of your masks.

NOTE: Supplies are limited - requests will be filled in the order received and while supplies last.

Your First Name *

Your Last Name *

Please provide your complete mailing address below

Your Street Address or PO Box *

Your City or Town

Your Zip Code *

Your Email Address *

Where did you hear about this program (optional)?

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Healthy Acadia Newsletter

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