Name & Credentials (if it applies-MD, DNP, RN, PA, CNM,)
Country you are Visiting Abroad
Point of Contact at Clinic
Shipping Information for Bag Delivery in US (if applicable)
Upon completion of this document, please attach a list of requested materials including consumable/disposable supplies, single use items, durable medical goods, electrical biomedical equipment & surgical tools.
I understand that submitting this application does not guarantee The Afya Foundation will fulfill on all items requested on this request. Afya relies on medical supplies donations from partner organizations. We will strive to include the majority of your requested items in your shipment.
Afya does not ship any pharmaceutical medications.