Patient and Family Emergency Services Fund

Dartmouth-Hitchcock’s Patient & Family Services Emergency Fund provides assistance to patients and their families who need help paying for medications, gas or transportation to and from medical appointments, or food while they are at DHMC.

If this is a gift in memory of or in honor of someone, please complete the Memorial and Honorary Gifts section at the bottom of this form.

 
Donation Information
$ 250.00
$ 100.00
$ 50.00
$ 35.00
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Additional Information
Billing Information
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Payment Information
Fundraising activities on behalf of Mary Hitchcock Memorial Hospital (MHMH) is conducted by Dartmouth-Hitchcock Health, a 501(c)(3) recognized charity by the IRS (EIN#26-4812335), for the benefit of MHMH. Your gift will appear on your credit card statement as a payment to "D-HHealth Donation".
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Matching Gifts
Memorial and Honorary Gifts