Skip to main content
1-800-472-6786

I appreciate being able to communicate with my healthcare team through MyChart and to have easy access to my medical information. I want to contribute to this technology with a gift to Sansum Clinic.

A Gift From:

Name

Address

Phone #

Email

Please Apply My Gift:

In Honor of

In Memory of

Send Notice of this Gift to

Gift Message

Address

In the Amount of:

Select Gift:

Payment Information:

Visa, MasterCard, American Express, Discover

Billing Address