Free Clinic of Simi Valley Donation Form – Give to the Free Clinic Today!

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

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Payment Instructions

1. Complete and click the button "Submit Donor Information" form above before moving to Donation Options.

2. Donation Options:

Donations by Credit Card - Select Amount:

A sampling of services that your donation provides:

Ten Childrens Fluoride Treatments

Two Pediatric Dental
Fillings

One Endometrial Biopsy to Screen for Cervical Cancer

Treatment of Two
Diabetic Patients for Vascular Ulcers

Five Treatments of Pre-Cancerous Skin Lesions

Three Periodontal Gum Surgeries

50 Well-Child Exams, including vaccinations

Find out more about this special group of donors, by clicking the button above.

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, 2060 Tapo Street, Simi Valley, CA 93063 - Tax ID: 23-7108154