Medical Supplies Donation Form

Medical Supplies Donation Form

Please complete the below form if you have a resource donation for healthcare facilities through SETRAC. Please note that there are minimal standards accepted in the medical community as far as donations. The items cannot be hand-made, or slightly used and packages such as gloves and others cannot be opened and/or partially used. FOR A DETAILED LIST OF ACCEPTED ITEMS, PLEASE SEE TABLE BELOW AND COMPLETE THE QUANTITY OF EACH ITEM TO BE DONATED WHEN APPLICABLE.
If you prefer to make a monetary donation, please follow link right below:

https://www.setrac.org/donate/
Organization making Donation (If applicable)
Donation Point of Contact Name*

First NameLast Name
Point of Contact 24/7 Phone Number*

Area CodePhone Number
Point of Contact Email*
example@example.com
County*

Resources available for Donation - (As of now, The below items listed are the only ones accepted by healthcare entities at this time) *

	Individual Quantity
N-95 Masks
Surgical Masks
Surgical / Isolation Gowns
Gloves (Boxes only, no loose gloves)
Hand Sanitizer
Anti-Bacterial/Microbial Soap
Disinfectant Spray / Wipes
Face Shields