Health4TheWorld COVID-19 PPE Drive: Hospitals/Health Care Professionals
Thank you for your participation in the H4TW C0VID-19 PPE Drive. Please fill out the brief form below to help us match a donation to you as efficiently as possible.
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What is your name? *
What is your email address? *
What is your cell phone number?
Do you represent a hospital? *
If you represent a hospital, what department and hospital do you represent? *
What is your title within your organization? *
Please provide your NPI number, website or LinkedIn to verify your hospital standing. *
Are you accepting only donations or can you pay a reasonable price for supplies? *
What supplies would you like to acquire via donation or reasonable sale? In the relevant spaces below, please mention the quantity needed for each item and the maximum cost per piece you can spend. If an item is needed as a donation, please enter '0'. If you do not need an item, please leave blank. For example, if you need 100 items donated, please list '100; 0'. *
Required
Nitrile gloves
Vinyl gloves
Medical grade N95 masks
Non-medical grade N95 masks
Surgical or procedure masks
Cloth masks
Safety goggles
Face shields
Protective gowns
Hair-covering bonnets
Shoe coverings
Bleach or disinfecting wipes
Hand sanitizers (CDC approved)
Other
What street address would you like supplies to be shipped to? *
What state would you like supplies to be shipped to? *
What ZIP code would you like supplies to be shipped to? *
What country would you like supples to be shipped to? *
Please provide any additional details that might help us best arrange supplies on your behalf.
Heath4TheWorld, Inc. is a California non-profit public benefit corporation.  As a charitable organization, our mission is to foster public health and access to healthcare education in under-resourced parts of the world.  We provide our services on a charitable basis and therefore make no claims, representations or warranties, whether express or implied, as to the safety, reliability, durability, performance, merchantability and/or fitness for any specific purpose of any products sold or donated by third-parties.  Health4TheWorld accepts no liability whatsoever for the safety, reliability, durability, performance, merchantability and/or fitness for any specific purpose of any such products. *
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