Soliciting Medical Devices Donations for the Injured

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you have crutches, wheelchairs, upper and lower limb braces, or other orthotic and prosthetic devices to donate to community members who have been hurt during the recent social and political upheaval in eSwatini, please fill in this form and we will get in touch with you.

Your First and Last Name *

Email *

WhatsApp number (incl. country code)

What type of medical device donation are you making? *

Orthotic (to support the spine or limb) [e.g. limb braces, neck brace, etc.]

Prosthetic (an artificial/manufactured replacement for a body part)

Medical kit (bandages, scissors, first-aid 🩹 kits, etc.)

Medicine; in particular, we are looking for those that help with pain management

Other:

Which drop-off zone would be ideal for you?

Mbabane

Johannesburg

Other:

Clear selection

If none of the above work, would you be opening to shipping your donation to one of our collection points

Yes

Maybe

Clear selection

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms