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PPE Request Form

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If you are a hospital, please utilize the established MHOAC procedures and email MHOAC@fresnocountyca.gov
 
The County of Fresno is currently procuring stocks of personal protective equipment (PPE) which will be available for distribution by request via the online form below.
 
Eligibility and costs incurred for items supplied will be determined prior to authorization of pickup/delivery. Supplies may not be available when requested.

 


Please correct the field(s) marked in red below:

1
PPE Requested
 *
PPE Requested
Requested Individual Quantity
Examination Gloves (Small)
Examination Gloves (Medium)
Examination Gloves (Large)
Examination Gloves (XL)
Disposable Gowns (Small)
Disposable Gowns (Medium)
Disposable Gowns (Large)
Disposable Gowns (XL)
Cloth Masks
Surgical Masks
Face Masks -- 3M N95 1860 S
Face Masks -- 3M N95 1860
Face Masks -- 3M N95 1870
Face Masks -- N95 Generic
Face Masks -- KN95
Face Shields
Shoe Covers
Bouffont Caps
Infrared Thermometer
Goggles
2
Your Name
 *
3
Company/Organization
4
Phone Number
 *
5
Email
 *
6
County of Fresno Business Address
 *
7
Billing Address (if applicable)
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