Equipment Details

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Equipment Details

Please provide a little information about what you would like to donate.

Email *

What equipment(s) would you like to donate? *

BPAP

CPAP

Oxygen Concentrator

Portable BP apparatus

Pulse Oximeter

Infrared Thermometer

Ventilator

Blood Pressure Machines

Medicines - Amphotericin / Tocilizumab / Apixaban/ Dexamethasone

Other

Required

How many total devices do you intend to donate? *

How old is/are the machine(s)? *

0-2 years (2019-2021 manufactured)

3-5 years (2016-2018 manufactured)

5+ years (2015 or earlier manufactured)

Other:

How many boxes would you need for shipment? *

Please list the Name and Model of the machine(s).

For any assistance, please contact:

Name of the Donor *

Address Line 1 *

Address Line 2

City *

State *

Zip Code/PIN *

Telephone Number

(123)456-7890

Send me a copy of my responses.

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