Thank you for your interest in helping the Alliance Health Clinic. Please print and complete this form, make your check payable to "Alliance Health Clinic" and mail it along with your payment to:
Alliance Health Clinic - 5952 El Cajon Blvd San Diego CA 92115.
Gift Amount* $
Please tell us where to direct this gift.
The Alliance Health Clinic as a whole for its greatest needs
Clinical activities, such as special equipment or tests
Patients' education and well being
Mr. Mrs. Ms. Dr. First Name MI Last Name
Street Address City State Zip
Home Phone Work Phone
Please provide us with an e-mail address so we may contact you if we have any questions about your gift
* If you have any questions, please call us at 619-286-9052 ext 234