Dartmouth Health

Your gift will help fund the treatments, innovations, and support services that mean so much when you or the people you love need the best care. Thank you for your generosity and joining us this GivingTuesday!

Please indicate the fund you would like to support in the form below. If this is in memory of or in honor of someone, please be sure to complete the Memorial and Honorary Gifts section at the bottom of this form.

Donation information

Amount:

Additional information

Anonymous:

I prefer to make this donation anonymously

Fund and/or additional gift information:*

Mailing address if different than billing address:

Billing information

Title:

First name:

Last name:

Country:

Street address or P.O. box:

City:

State:

ZIP:

Phone:

Email:

Payment information

All donations are tax deductible to the fullest extent allowable by law. Fundraising is conducted by Dartmouth-Hitchcock Health (EIN#26-4812335), a 501(c)3 charity recognized by the IRS. Your gift will appear on your credit card statement as a payment to “DHealth Giving.”

Cardholder’s name:

Credit card number:

Card type:

Card expiration:

Card security code:

Memorial and honorary gifts

Is your gift in memory of or in honor of someone? If so, please complete this section.

Type:

Full name of honoree:

Mail a notification letter on my behalf

Matching Gifts: If your employer will match your gift, please submit the matching gift form to Medical & Healthcare Advancement, One Medical Center Drive, HB 7070, Lebanon, NH 03756

Recurring Monthly Gifts: If you would like to pledge a recurring monthly gift, please call Medical & Healthcare Advancement at (603) 653-0700 or email DH-Geisel.Gift.Recording@hitchcock.org

Prefer to send a check?

Visit our website for our mailing address and instructions for how to make out your check.

Need help?

Do you have a question or need help making your gift? Please call us at 603-653-0700. We’re happy to help!