Donate Now - Fourth Street Clinic

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Thank you for your generous gift to support Fourth Street Clinic. Your gift is critical to support Fourth Street Clinic in providing homeless Utahns essential and quality comprehensive health care including medical and dental services, case management, mental health, substance abuse treatment, access to speciality care and wellness classes. Your gift today provides a path to good health. Together we will make a difference. Thank you!!!

Donation Information

Amount:

$3,000 one year of health care for a family

$ 3,000.00

$750 one year of health for an individual

$ 750.00

$500 purchases medical supplies and equipment

$ 500.00

$250 purchases vaccines for children

$ 250.00

$150 funds one comprehensive medical visit

$ 150.00

$15 fills a prescription

$ 15.00

Other

$

*

Additional Information

Frequency:

On:
Starting: Ending:

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

Billing Information

Title:

First name:

*

Last name:

*

Country:

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Address lines:

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City:

*

State:

*

ZIP:

*

Phone:

*

Email:

*

Payment Information

Cardholder's Name:

*

Credit Card Number:

*

Card Type:

*

Card Expiration:

/

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Card Security Code:

help

*

Matching Gifts

My company will match my gift

Company:

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© 2016 Fourth Street Clinic | 409 West 400 South, Salt Lake City, Utah 84101 | Phone: 801-364-0058 | Fax: 801-364-0161

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