Donate Now to the
Free Health Center

Complete an online donation below using a credit card. Your name and address are required to acknowledge your donation.

If you have trouble filling out the form, please call 513 862 3786.

Other Options

Print and Mail Form

Please download, fill out and mail this form.

Donate by Phone

Call us at 513 862 3786 in order to make a donation over the phone.

Donation Information

Amount:

$ 25.00

$ 50.00

$ 75.00

$ 100.00

$ 500.00

Other

$

*

Additional Information

Type of gift:

One-time gift

Recurring gift

Frequency:

On:
Starting: Ending:

Corporate:

This donation is on behalf of a company

Additional Comments:

Billing Information

Title:

First name:

*

Last name:

*

Country:

*

Address lines:

*

City:

*

State:

*

ZIP:

*

Phone:

Email:

*

Tribute Gift

This gift is in honor, memory, or support of someone

This gift is:

*

Full Name:

*

First name:

Last name:

*

Mail a letter on my behalf to

*

© 2024 Good Samaritan Foundation | 375 Dixmyth Avenue, Cincinnati OH 45220