• This form should only be used to request supplies and resources other than Personal Protective Equipment (PPE) or Ventilators
  • All requests for supplies other than PPE or ventilators should be made by submitting this form to GNYHA at: covidsupplies@gnyha.org. Please note Organization Name and ‘Supply Request’ in email subject.
  • ALL sections of this form MUST be completed for request to be submitted.
  • As a reminder, there may be costs associated with any supplies provided pursuant to this supply request.
  • Please limit request size to ONE (1) WEEK of anticipated demand for the product(s).