Make a Medical Donation or Request Further Information

If you are a human and are seeing this field, please leave it blank.

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If you are interested in making a donation of products and/or equipment, please fill out the form below and we will respond within one to two business days.

Due to strict regulations in the United States and abroad, MedShare encourages the donation of products that have at least 12 months of use before they expire.

Contact Information

Name *

Today's Date *

Email *

Phone *

If "Other", please specify:

Questions/Notes

If you have products or equipment to donate at this time, please describe your items in the fields below.

Donation #1

Product

Quantity

Expiration Date

For biomedical equipment and beds, please include model numbers, availability of manuals/spare parts, needed repairs and age:

Additional Information:

Donation #2

Product

Quantity

Expiration Date

For biomedical equipment and beds, please include model numbers, availability of manuals/spare parts, needed repairs and age:

Additional Information:

Donation #3

Product

Quantity

Expiration Date

For biomedical equipment and beds, please include model numbers, availability of manuals/spare parts, needed repairs and age:

Additional Information:

Donation #4

Product

Quantity

Expiration Date

For biomedical equipment and beds, please include model numbers, availability of manuals/spare parts, needed repairs and age:

Additional Information: