Face Mask Request Form for Health Care Professionals

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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 *

Name of healthcare facility *

Contact Name:

Phone number *

Address:

Does your organization currently have access to face masks? *

Yes

Other:

Is your team members working directly with COVID-19 patients? *

Yes

Possibly

What type of masks would be most beneficial to you?

Basic Face Masks- Made of 2 layers of 100% cotton fabric, with a layer of non-woven interfacing or light-weight flannel in the middle. (Also has a space to insert a filter if available.)

Face Mask Covers- Designed to fit over N95 masks to help extend their use.

Clear selection

How many masks is your team in immediate need of? *

Submit

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