The Michigan Community Service Commission, the state’s lead agency on volunteerism and donations management during times of crisis, is coordinating the state’s collection and disbursement of donations of essential items most needed by hospitals and healthcare professionals during the COVID-19 pandemic. The Commission is partnering with MAFP to identify and quantify the needs of family physicians across the state.

If you or your practice is in need of essential items (e.g., masks, sanitizer, gloves, gowns, no-touch thermometers), please complete this form. MAFP will forward requests to the Commission for consideration as materials become available.

The Michigan Community Service Commission also recommends that family physicians / practices in need of supplies contact their local Emergency Operation Center. EOC’s are part of the state’s network of local, state, and federal emergency and disaster coordination efforts. Michigan's EOCs organized by county.

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* 1. My contact information:

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* 2. Overall, I rate my need for essential materials as:

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* 3. Name of practice / healthcare organization:

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* 4. City where practice / healthcare organization is located:

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* 5. County where practice / healthcare organization is located:

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* 6. Region in which the practice / healthcare organization is located (click here for an interactive map of Michigan's regions):

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* 7. My practice / organization is accepting the following essential materials (check all that apply):

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* 8. Address where donations should be shipped:

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* 9. Process for my practice to receive donations:

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* 10. Website of my practice / healthcare organization:

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