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COVID SUPPLIES
IBDMoms is here and ready to help if you are in need of Covid protection items. These supplies are also perfect for all viral outbreaks, etc. Please fill this out and we will do our best to get you what you need.
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NAME
*
Please give us your full name (First and Last)
Your answer
EMAIL
*
Your answer
PHONE
*
Your answer
ADDRESS
*
Your answer
PATIENT or CARGIVER
*
Please indicate whether you are a patient living with IBD or if you are caring for a patient with IBD.
Patient
Caregiver
Pediatric Patient
NEEDS
*
Adult Masks
Kid Masks
Cleaning Supplies
Covid Rapid Tests
Blood Oxygen Monitor
Respiratory Measurement
Alcohol
Spray Bottles
Gloves
Covid Care Package (Items you may need if Covid effects your household)
Pre-Covid Bundle (Masks, Lysol Wipes, Alcohol, Spray Bottles, Hand Sanitizer, Covid Tests)
Covid Travel Pack (Travel bundle to take with you if you have frequent travel needs)
Other:
Required
ANY ALLERGIES?
Please let us know whether you have allergies or certain brands you must use.
Your answer
Please let us know any other challenges or needs you are facing that may not have been listed here.
Your answer
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