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Online Meal Donation Intake Form
All donations require a delivery appointment. Please provide preliminary information to assist with delivery scheduling.
Name
*
First
Last
Company, Group or Organization if Applicable
Email
*
Phone
*
Number of meals or items donating (min. of 25)
*
Please enter a number greater than or equal to
25
.
Which Inova facility are you interested in supporting? (check as many as apply)
Inova Alexandria Hospital
Inova Ashburn Healthplex
Inova Fair Oaks Hospital
Inova Fairfax Hospital
Inova Lorton Healthplex
Inova Loudoun Emergency – Cornwall Campus, Leesburg
Inova Loudoun Hospital
Inova Mount Vernon Hospital
Inova Springfield Healthplex
Other
Other Inova facility
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First Name
Last Name
Email
*
Email
This field is for validation purposes and should be left unchanged.