Support Good Samaritan Hospital Medical Center's
Crisis Response Fund

                

Our Healthcare Heroes are counting on you!
Please complete the form below to make your donation.

Your donation will help Good Samaritan Hospital Medical Center
to meet our most critical needs now.
 
Donation Information
$ 500.00
$ 250.00
$ 100.00
$ 50.00
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  Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
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Questions? Contact Ashley King at 631-678-8002 or Ashley.King@chsli.org. 
To make a gift by mail, use our printer-friendly version of this form and send it with your check to:

Good Samaritan Hospital Foundation
1000 Montauk Hwy.
West Islip, NY 11795
Please make checks payable to the Good Samaritan Hospital Foundation.