Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * URGENT CARE FOUNDATION TAX-DEDUCTIBLE CONTRIBUTION This Site Secured By SSL Encryption
Donation Information
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DONATE TO HURRICANE HARVEY RELIEF EFFORTS  *
(Select All/None)
Thank you for supporting families and urgent care providers impacted by Hurricane Harvey! While the rain may have finally stopped and the flood waters are beginning to recede, relief efforts are just beginning. Your donation will help to provide immediate access to primary care resources for tens of thousands of residents in Texas and Louisiana. All donations are tax deductible.
In Honor/Memory of
If you wish to make your contribution in honor or in memory of someone, please indicate such. Please also include contact information for the person(s) you would like us to notify of your contribution.
Donor Comments
Donor Information
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Billing Information
[ Click here if billing address is the same as donor address ]
 *  
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