Good Samaritan Hospital Los Angeles - Charitable Donations

physician referral: 1 800 GS CARES
general hospital: 213-977-2121
info@goodsam.org

On-line Giving Form

(Please note: An email address is required to process this transaction.)

Yes! I want to support Good Samaritan Hospital with a gift of $
[PLEASE DO NOT USE COMMAS OR DOLLAR SIGNS: 1000 or 1000.50 WORKS. 1,000 or $1,050 DOES NOT WORK]

I would like to make a one time gift
I would like to make my donation a recurring gift

Please direct my gift to:

Hospital's Greatest Need

Cardiology

Cancer

Orthopedics

Davajan-Cabal Center for Perinatal Medicine

Other, please specify:

This gift is in honor of/in memory of:

Donor Info:

Check this box if this is an Employee/Good Company gift

First Name:

Last Name:

Address:

City:

State:

Zip:

Telephone Number:

Email Address:

I am asking my company to make a matching gift.

I have remembered the Hospital in my will or living trust.

Please send information to me to help organize my estate.

Please send me information on making a gift that may provide me with life income and tax benefits.

Card types: We accept Visa, Mastercard, American Express and Discover. Our system will determine which card you're using based on the Card Number.

Name on card: (*)

Card Number: (*)

Expiration Date:

Month: Year:

Good Samaritan Hospital provides notice to its public that when an individual has any concerns about patient care and safety in the hospital, that the hospital has not addressed, he or she is encouraged to contact hospital management at 213-977-2299. The public may contact the Joint Commission's Office of Quality Monitoring to report any concerns or register complaints about a Joint Commission-accredited health care organization by calling 1-800-994-6610.

© 2011 GOOD SAMARITAN HOSPITAL
1225 Wilshire Blvd. • Los Angeles, CA 90017
213-977-2121 (General Hospital) • 1 (800) GS-CARES (Physician Referral) • info@goodsam.org

Medical Websites by HealthPresence

On-line Giving Form

Recurring Billing Info: (Billed Monthly)

Please direct my gift to:

Donor Info:

Card types: We accept Visa, Mastercard, American Express and Discover. Our system will determine which card you're using based on the Card Number.