At AvaCare Medical, we are dedicated to helping our customers, as well as others in need. This is especially true in times of crisis, when people are left vulnerable and desperate for assistance. That is why we have created the AvaCare Medical GIVES initiative, a concentrated effort to Give In Vulnerable Emergency Situations (GIVES).

We believe that in challenging times, the world should come together and give in every way possible. Through GIVES, we aim to provide those affected with the funds, medical supplies, and equipment they need to start rebuilding their lives. We are proud to be able to make a difference in the lives of those in need and hope our efforts will have a lasting impact.

Please take a few moments to complete the Request for Assistance Form below if your nonprofit organization is in need of donations to increase its impact in a community or area contending with a recent disaster. We look forward to hearing how we can help!

PRIMARY CONTACT INFORMATION

Primary Contact First Name*

Primary Contact Last Name*

Primary Contact Title

Primary Contact Email

Primary Contact Phone Number*

Which of these best describes the primary contact?

Select OptionIndividualDirector of Nonprofit Charitable OrganizationRepresentative of Nonprofit Charitable OrganizationDirector/Representative of Other Organization

How did you hear about AvaCare Medical G.I.V.E.S.?

Select OptionCommuniqueCommunity bulletin boardCommunity organizationEducational institutionEmailEmployerFEMAFlyer or posterFriendHospital/hospiceInternetNews articleNews broadcastNonprofit organization or websiteReligious institutionSocial mediaUSA Government

NONPROFIT ORGANIZATION INFORMATION

Individuals, skip to Donation Request section below.

Name of Nonprofit Organization to Receive Assistance

Nonprofit Organization EIN Number

Nonprofit Organization Website

Nonprofit Organization Assessment

(Provide a URL to the organization's page on Give.org, CharityNavigator.org, and/or Guidestar.org)

Nonprofit Organization Address

Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democratic Republic of the CongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.s.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

DONATION REQUEST

What is the current condition of the potential recipient(s), and what are the primary challenges that you are seeking to overcome?

Medical Supplies & Equipment Requests (e.g. beds and mattresses, diabetic meters & strips, first aid kits, IV poles, manual wheelchairs, mayo stands, otoscopes, overbed tables, pulse oximeters, scales, sphygmomanometer, stethoscopes, table paper,etc.)

AvaCare Medical Product Requests (Provide item numbers for specific products listed on our site)

Financial Needs

Other Needs

Please share any specific needs for medical equipment and supplies, if any:

Please share any information and stories that you feel would be helpful in considering this Request for Assistance: