Request for Covid-19 Medical Supplies - Medpick

Name of the Hospital*

Name of the person in charge*

Email*

Phone*

WhatsApp Number (to receive updates)

Country*

Street Address1*

Street Address2

City*

State / Province*

Pin Code*

Website URL

Please choose from the following supplies and mention the quantity you need*

Please provide us with as much as information about your hospitals.

How many healthcare professionals in your organization are currently fighting the Covid-19 crisis.?*

What difficulty is your hospital currently going through with the lack of PPE kits.