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Online Donations
Contact Information
Amount
*
$25
-
Provide a vaccine for a patient
$50
-
Buy a patient a home blood pressure monitor
$75
-
Supply the clinic with toothbrushes, toothpaste, and floss for a month
$100
-
Support a day of language interpretation services
$250
-
Give 8 patients a vist with our dental hygienist
$500
-
Provide 20 hours of mental health services
$1,000
-
Give 8 people a visit with our dentist
$
Donation Schedule
One Time
Monthly
Weekly
Name
*
Prefix
First Name
Last Name
Suffix
Spouse/Partner Name
Prefix
First Name
Last Name
Suffix
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Email
*
Verify Email
*
Phone
*
Note
This donation is in honor or in memory of someone.
select one
In honor of
In memory of
This gift is in honor of/in memory of:
Make this donation anonymous.
Yes
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