If your clinic continues to have difficulty finding PPE through private suppliers, please fill out the AMS PPE Form below.

NOTE: If you completed a PPE form SINCE  9/11/20, you do NOT need to complete a new one.

Please only list those items that you are unable to purchase or unable to purchase at a reasonable price.

PLEASE SUBMIT ONLY ONE FORM PER CLINIC.

If your clinic has multiple locations please include the needs of all locations on one form.

PPE Shipment September 2020

    Check all that apply.
  • There is no cost for the PPE. If you choose to have items shipped, we will be sending you an invoice to pay for the cost of postage.