Free Clinic of Simi Valley Donation

Free Clinic Donation Form

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Donation is from more than one person or a business (e.g. Married Couple (Bob & Sue Donor), Benevolent Company) *

Special Instructions or Notes From Donor. If this gift is in Tribute or in Memoriam, please provide information and address for a card to be sent here: *

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What can your gift do?

$20 - 10 Childrens Fluoride Treatments
$35 - 2 Pediatric Dental Fillings
$50 - 1 Endometrial Biopsy to Screen
for Cervical Cancer
$75 - Treatment of 2 Diabetic Patients
for Vascular Ulcers
$100 - 5 Treatments of Pre-Cancerous
Skin Lesions
$250 - 3 Periodontal Gum Surgeries
$500 - 50 Well-Child Exams, including
Vaccinations

Payments can be made via any credit card or by PayPal. Payments are processed through PayPal, but you are not required to have a PayPal account.

Donations by Check
Please make checks payable to: Free Clinic of Simi Valley (FCSV).
Please mail checks to: Free Clinic of Simi Valley, 2003 Royal Avenue, Simi Valley, CA 93065 - Tax ID: 23-7108154