Medical Volunteer and Staff Request

Response Partner Resource and Personnel Requests

PCHD is coordinating relief efforts to get healthcare and other response partners the supplies and support they need. Current stock is limited and requestors are encouraged to continue working with their commercial suppliers in addition to requesting support from PCHD.

In order to move forward with making your account, please use the form below with the following required information:

  • The name of your organization’s single point of contact
  • Organization name
  • Type of service provided by your organization
  • Email for the point of contact
  • Phone Number for the point of contact

As the logistical point of contact, you will be the sole individual responsible for entering and managing order requests on behalf of your agency. Once this single point of contact for your organization is identified, we will reach out to them with instructions on how to submit a request for PPE through the Survey 123 system.

   All requests will be sent to our logistics staff to be screened and verified.

* indicates required fields.
Medical Volunteer and Staff Request (
First Name: *  
Last Name: *  
Agency Name: *  
Agency Type: *
Email: *
Phone: *

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Tucson, AZ 85714

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