Request an Envelope | MHYH: Envelope Request Fulfillment

This request is on behalf of a...

Organization Name

First name

Last name

Street address

City

State

Zip code

Phone number

Email (confirm)

Number of devices you expect to send

You may request envelopes to send back up to 90 devices at a time.

Specific questions or comments regarding pacemaker donation? Please contact us at MCORRPMHYH@med.umich.edu.