Request Supplies

Kaiser Supply Order Form

Please complete this form when requesting supplies for your department. Requests for supplies are processed during normal business hours and may take up to 7 to 10 business days to be delivered. Please plan in advance when requesting passes for your department. DO NOT USE THIS FORM TO SEND ITEMS TO CLIENTS.
Supply Order Information
Name*
First Last
Email*
Phone*
Select the medical centers to which you will be distributing the supplies:
- KPB
- Sunnyside
- Westside
Delivery Information
Attn:
Company
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Special Instructions
Shelter Voucher and Meal Coupon Selection
Please enter the number of booklets or coupons that you are ordering for your department. Allow 3 to 4 business days for passes and/or vouchers to be delivered.
City Team Ministries Voucher Booklet(s) - 25 vouchers per booklet
Sisters of the Road Meal Coupons
Transit Pass Selection
*UPDATE* Trimet has discontinued the pink foil-stamped paper tickets and will no longer be accepting them after December 31st, 2019. They have fully transitioned over to the HOP program and have replaced the pink ticket booklets with single use paper HOP passes. As the booklets are no long available, please enter the number of single use passes that you are ordering for your department.
TriMet Adult 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed
TriMet Adult All Day Single Paper Tickets - Enter total number of individual tickets needed
TriMet LIFT 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed (please only enter multiples of 10)
Columbia Area Transit Passes - Enter quantity
Columbia Area Transit Passes - Enter type
C-Tran All Zone Day Passes
C-Tran Express Day Passes
C-Tran Monthly Passes - due on the 14th of the previous month
Scales
Please indicate the number of scales needed. We currently provide 550 lb. maximum talking scales for adults and 44 lb. maximum scales for babies.
Number of Adult Scales
Number of Baby Scales
Testing Devices
Please indicate the number of each device needed.
Number of Blood Pressure Monitors
Number of Oximeters
Car Seats
Please indicate the number of car seats needed for your department. Use Clara to record distribution of car seats, or to order individual seats for clients.
Number of Car Seats
Notes/Comments
Please indicate any notes or comments about this order