Face Shield/ Mask Order Form

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Face Shield/ Mask Order Form

Please complete this form to request PPE to be shipped to your clinic. Please request only what you need as these resources are limited. We will do our best to honor your request but cannot guarantee that all requests will be filled.

Face shield requests must be received by 9 am on 8/10/20.

Note: ODH is covering to cost of shipping reusable face masks. If you need face shields, we will invoice you for the cost of shipping.

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Email *

Your email

Name: *

Your answer

Clinic Name: *

Your answer

What address do you want the PPE shipped to? *

Your answer

How many face shields would you like?

Your answer

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