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

  • Delivery Information

  • 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.
  • 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.
  • 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.
  • Testing Devices

    Please indicate the number of each device needed.
  • 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.
  • Notes/Comments