Maricopa County Medical Society (MCMS), through items provided by the Maricopa County Department of Public Health, is distributing free PPE to practicing physicians in the county. Since hospitals already receive supplies from the state and county, these items will be for physicians in private practice. Given the high demand and limited supplies, please request PPE by completing this form. MCMS will share details about when to pick up your supplies and what has been allocated to you.

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* 1. Please provide some contact information.

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* 2. What is your medical specialty?

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* 3. Are you a member of the Maricopa County Medical Society?

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* 4. Which items are you requesting?

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