1. Choose how you want to help below.

$25 pays for one flu shot.

$40 pays for one birthing class for an expectant couple.

$110 pays for one prenatal visit.

$150 pays for one office visit.

$375 pays for nutritional counseling and supplies for a newly diagnosed diabetic.

$550 pays for flu shots for 25 seniors.

$875 pays for a full course of well child visits from birth to age one.

$1,210 pays for a full course of prenatal care.

$1,975 pays for one full day of an off-site clinic for at-risk teens.

$2,250 pays for a full course of well child visits from birth to age ten.

Other: $ ($10 minimum)
All donations help our patients!

2. Would you like to make your gift ongoing?

I would like to make this a one-time gift.

I would like to make this gift ongoing.

I would like to make this donation
and I want to make payments.

Thank you for choosing to make an ongoing donation. Your donation can be changed or cancelled at any time. For more information about this option, visit our information page.

3. Please choose how we should apply your gift:

Annual Fund

Luncheon Gift

Please enter the name of your Luncheon Host:

I am making this donation in memory of someone.

I am making this donation in honor of someone.

Please enter the name of the person you are making this donation in memory or honor of:

Optional:
We would be happy to send a notification letter to someone informing them of your tribute gift. If you wish to send a notification, please check the box below and enter the recipient's mailing address.

Note: This will appear on the order form as "Shipping Information."

Yes, send a notification letter.

Recipient Address:

Name:

First Name

Last Name

Street:

City:

State:

Zip Code:

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Thank you for your interest in donating to the Clinic!