Medical Equipment

Application

BACK THE BADGE USA

Donate

Medical Equipment

Application

Who we are and why we need this info.

See the contents of the medical equipment bags:

Bag Contents

Medical Equipment Application Form

Full Name

Title (Example: Sheriff, Sterling County PA)

Email *

Phone *

Office (Desk) Phone

How many (total) patrol vehicles does your department have?

Do any of them have advanced medical equipment in them?

If so, what medical items do they currently have?

How many stations does your department have?

Do you have an infirmary at any of your stations?

Additional Notes

If we are able to do a medical equipment donation to your department, we will contact you well in advance of any donation event that we will be holding.

Please submit you answers via the form above. However, if you are looking to print out a form please click the link below and then mail it to us at [email protected].

https://docs.google.com/document/d/1Zk8zdurELxBAA7lrJpLvepp8pO1q_8QHzAwYBrr1r-U/edit?usp=sharing

Medical Equipment Application

Medical Equipment

Medical Equipment

Who we are and why we need this info.

See the contents of the medical equipment bags:

Medical Equipment Application Form

Please submit you answers via the form above. However, if you are looking to print out a form please click the link below and then mail it to us at [email protected].

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