SHC Item Donation Form 2022

SHC Equipment and Supplies Donation Form

We value your generosity. Equipment and supply donations help us provide better patient care. Our needs are particular, please review the form below and we’ll promptly respond after submission.
Please Select All Items You Want to Donate

If an item is not explicitly listed below, we do not accept it.
Would you like to make a Monetary Donation to Sinclair Health Clinic?
Thank you!

Your additional donation will allow us to purchase new medical equipment and supplies to ensure we continue to provide high-quality care to our growing number of patients.

You will be redirected to our donations site when you complete and submit this form.
CPAP SUPPLIES: Factory sealed, unopened. We do not accept CPAP or Bi-PAP machines.
MEDICAL EQUIPMENT: Considered as needed. Must be in Good or New condition. Wheelchairs must be unpowered.
MEDICAL SUPPLIES: Factory sealed, unopened.
OFFICE EQUIPMENT: Rolling chairs must be in New condition. ScanSnap Scanners must be in Good or New Condition. Tablets (Andriod) and Monitors must be manufactured in 2020 or later, in Good or New condition, and returned to factory settings.
Your Information
Your Name*

PrefixFirst NameLast NameSuffix
Email
example@example.com
Cell Phone Number

Area CodePhone Number
Can we leave messages at this number?

YesNo
Home Phone Number

Area CodePhone Number
How do you prefer to be contacted?*

Cell phone callCell phone textEmailHome phone call
Address (for tax purposes)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A Few Things to Know

Please answer and mark as appropriate before submission.
About Sinclair Health Clinic:

Since 1986, Sinclair Health Clinic, federal non-profit EIN #: 54-1373296, has been serving the medically underserved residents of the City of Winchester, Frederick County, and Clarke County. We are located at 301 North Cameron Street in Winchester , VA 22601
Date*

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Date
Signature, sign below these words using your mouse*
Sorry that we don't accept your items:

You can receive this info by email, just enter your address above and click the [Donate These Items] button -OR- You can find this information on our website.

Other organizations that may accept the equipment and supplies that we do not:

EQUIPMENT++:

F.R.E.E Foundation: (540) 664-7552

https://www.free-foundation.org/get-involved

F.R.E.E. welcomes donations of gently used items. They accept the following equipment:

o   Walkers and wheeled walkers

o   Canes and crutches.

o   Bath and toilet aids, including shower chairs and tub transfer benches

o   Manual and power wheelchairs

o   Hoyer lifts and other specialty equipment

o   Bariatric equipment.

Medical Missionaries: 703-335-1800

https://medicalmissionaries.org/donate-supplies/

They are located in Manassas VA. They do not pick up; you must deliver to them.

o   Medical equipment – new or gently used and in working condition – such as crutches, walkers, shower chairs, commodes, hospital beds and hospital mattresses

o   They do not accept CPAP machines.

SUPPLIES++:

Medical Missionaries: 703-335-1800

https://medicalmissionaries.org/donate-supplies/

Located in Manassas VA. They do not pick up; you must deliver to them.

o   Medical Supplies – most medical supplies are accepted. Please contact the office for details.

o   They do not accept prescription medications.

o   Medical office equipment – such as exam tables, lights, file cabinets, etc.

o   Clothing and shoes – must be clean and in good condition, only new, “like new” or gently worn items (no stains, holes or soiled items; no undergarments, unless new)

o   Household supplies – new or gently used (please no glass or electrical items)

++The organizations listed here are only those we know to accept donations. If you find others, especially those accepting medical supplies locally, please email us so we can list them here.

Again, thank you for thinking of us.
Should be Empty:

SHC Equipment and Supplies Donation Form

Please Select All Items You Want to Donate

Your Information

A Few Things to Know