Pulse Oximeter Request Form
Thanks to the support from the Maine Department of Health and Human Services, Healthy Acadia has a limited* number of pulse oximeters available upon request for residents of Washington and Hancock counties, Maine, who are at high risk for severe symptoms from respiratory illness.  Limit of one device per household. The device will be mailed to you by U.S.postal mail. Please provide your complete shipping address below to ensure proper delivery.

UPDATED NOTE 12/29/2022: Due to a large volume of requests, orders will be filled in the order received, there may be a delay in your order as we wait for additional oximeters.
Sign in to Google to save your progress. Learn more
Your First Name *
Your Last Name *
Please provide your complete mailing address below
Your Street Address or PO Box *
Your City or Town
Your Zip Code *
Your Email Address *
Your phone number
Where did you hear about this program (optional)?
Clear selection
Do you want to receive Healthy Acadia's bi-weekly e-newsletter and occasional email updates throughout the year delivered directly to your inbox? *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Healthy Acadia. Report Abuse