Submit Progress Report & Order

Prior to resupply of Diflucan®, each organization is required to submit a Progress Report describing how the previous donation was used. At the time of submitting the Progress Report, each organization will be able to submit a resupply request. The Diflucan® Partnership Program reserves the right to amend this request based on information collected on the organization’s program.

To complete a progress report and order, please download the form . Note: to read, edit and save this form, you must have Adobe Acrobat 8.0 or later. Visit to download the most current version.

When you have completed the form, please send it as an email attachment to

Download the Progress Report and Order Form

If you have questions, email us at

Contact us by phone in South Africa:
+27 11 351 1287

In the U.S.:
+1 805 964 4767


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Direct Relief is a registered 501(c)(3) organization.
Direct Relief
27 S. La Patera Lane
Santa Barbara, CA 93117
Phone: (805) 964-4767
Fax: (805) 681-4838
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