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

Yes! I want to support Good Samaritan Hospital with a gift of $ for:

Area of Greatest Need:

Heart Institute

Neurosciences Program

Orthopedic Institute

Pancreato-Biliary Institute

Davajan-Cabal Center for Perinatal Medicine

Tertiary Retinal Surgery

Transfusion-free Medicine & Surgery

Peter D. Fugelso, M.D. Urology Center

Other, please specify:

Charge my:

Visa Mastercard

American Express Discover

Name on card:

Card Number:

Expiration Date:

Month: Year:

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.

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.

© 2008 GOOD SAMARITAN HOSPITAL
1225 Wilshire Blvd. • Los Angeles, CA 90017
213-977-2121 (General Hospital) • 1 (800) GS-CARES (Physician Referral) • info@goodsam.org

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