Request Form for Homemade Gown PPE Delivery in London-Middlesex
As a result of the COVID-19 pandemic, there is a marked shortage of personal protective equipment (PPE) available for members of the healthcare community. This form allows primary care healthcare providers in London, ON to request PPE gowns made by local sewers for use by staff.

Ordering:
Due to high demand, you may currently only request up to 20 gowns. Additional gowns can be requested once the initial gown order has been delivered.

Production:
The gowns are produced and distributed in collaboration with the London-Middlesex Primary Care Alliance and Canada Sews. They will be packaged in a sealed bag and quarantined prior to delivery.

Delivery:
The delivery will be made to the location indicated. If necessary, please provide additional directions for the drop-off location. We will reach out to you when the delivery is ready to be made.

Time For Delivery:
Due to high demand for gowns, our volunteers are doing their best to fill orders as quickly as possible. However, it will take up to several weeks to fulfill your requests for gowns. The orders will be processed on a first come first serve basis.

PLEASE NOTE: ITEMS MUST BE WASHED BEFORE USING. WE MAKE NO REPRESENTATION OR WARRANTY AS TO THE EFFECTIVENESS AND QUALITY OF THESE GOWNS. BY ACCEPTING AND WEARING THESE GOWNS, YOU ACCEPT THE RISKS ASSOCIATED WITH WEARING THIS PPE OVER MEDICAL-GRADE PPE. THESE GOWNS ARE TO BE USED AS A LAST RESORT. IF YOU HAVE ACCESS TO MEDICAL-GRADE PPE, USE THAT FIRST. PLEASE ENSURE RECIPIENTS ARE PROPERLY TRAINED FOR SAFE USAGE. OVERUSE, IMPROPER USE, OR EXTENDED CONTINUOUS USE MAY DECREASE THE EFFECTIVENESS OF THESE GOWNS. BY ACCEPTING AND WEARING THE ENCLOSED GOWNS, YOU ACKNOWLEDGE, UNDERSTAND AND ACCEPT THE RISKS ASSOCIATED WITH DOING SO AND HEREBY WAIVE ANY AND ALL CLAIMS WITH RESPECT TO THE EFFECTIVENESS AND QUALITY OF THESE GOWNS.


If you have any questions, please contact us at: canadasewsgowns@gmail.com
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Name of organization/clinic *
Contact name (first and last name) *
Contact email *
Contact phone number *
Number of gowns required (additional gowns may be ordered in the future based on available supply) *
What size gowns would you prefer? (Please note that we may not be able to accommodate all requests)
Delivery address *
Specific delivery instructions (if necessary, such as if the dropoff location is in a large complex)
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