Use the form below to request your single-use (disposable after one time use) Clear Mask (PPE) from ACDHH. These masks have been donated for distribution to Arizona residents by the Maricopa County Board of Supervisors.


Please answer all questions to ensure your request is complete. We will use the e-mail address listed to contact you if we have further questions about your eligibility or delivery instructions. The masks are available only while supplies last, and are distributed on a first-come, first-serve basis. 

To ensure masks are equally distributed, if you are requesting for school use, we ask that you utilize this resource as a last resort.

10 masks will be distributed per request.

If you have trouble using this form, please contact us via email at: 

You may also contact us via telephone at the following numbers:

602-542-3323 V and 480-559-9441 VP

For DeafBlind individuals, or those with Combined Vision and Hearing Loss (CVHL) who need assistance in completing the form, please contact Julie Stylinski via email at:

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* 1. Please enter your contact information below to receive clear masks. Please reply "N/A" to items which do not apply.

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* 2. County of Address Listed Above Within the State of Arizona

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* 3. Type of Phone Number Provided Above

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* 4. Is this request for a business/organization or household?

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* 5. Which of the following best describes the individual(s) whom will be using the masks? Check all that apply.

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* 6. Do you plan to use these masks yourself or for others who interact with you? Check all that apply.

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Clear masks being shipped as of November 2020 were donated to the public by the Maricopa County Board of Supervisors. The ACDHH is distributing them as a courtesy, was not involved in the purchasing or product selection process, and cannot verify the effectiveness of the masks. Please indicate below that you have read this statement by checking the acknowledgment box.