Westside Family Healthcare Medical Supplies Donation Form

Westside Family Healthcare is on the front lines of keeping our communities safe and well. We are here to fight the spread of coronavirus and to keep our patients healthy.

Westside is now accepting supply donations to help keep our workforce healthy and our doors open. Donated items must be in unopened, original packaging. At this time, we are not accepting homemade supplies.

Please note: cash donations allow Westside to respond as quickly as possible to urgent needs of the community. Make a cash gift to Westside Family Healthcare.

THANK YOU for your generosity and your commitment to Westside.

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* 1. Contact Information

First Name

Last Name

Phone

Email Address

Mailing Address (Street, City, State, Zip)

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* 2. Please indicate the quantity of each item that you will donate (if 0, leave blank).

Medical grade surgical masks

Protective medical gowns

Goggles, safety glasses and face shields

Disinfectants and/or disinfecting wipes

Latex-free medical gloves

Digital thermometers (general use)

Hand sanitizer

Laptop computers

Other (please describe)

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* 3. Are you donating on behalf of an organization? If so, please provide the organization name.

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* 4. Other information/comments/etc.

Please email externalaffairs@westsidehealth.org to coordinate donation delivery.

All donated items are tax deductible. Westside Family Healthcare is a 501(c)(3) non-profit corporation, and has not provided any goods or services in return for your contribution. Our employer tax identification number is 22-2488654.