Demande de Don - Medical donation

Donation Request: Medical donation

Fill out this form step by step to submit your medical donation request. Your health is our top priority.

For medical safety reasons, please provide all necessary documents.

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Full Name

Email Address

Phone Number

Full Address

Identification Document (PDF, JPG, or PNG)

Choose a file

Type of Medication or Medical Equipment

Required Quantity

Prescription or Medical Proof (PDF, JPG, or PNG)

Choose a file

Urgency Level

Delivery Address

Additional Medical Information