Make a Donation

Did you know?

Burgess has two family clinics to meet your healthcare needs located in Mapleton and Sloan, Iowa.

For your convenience, you may use this secure form to make a donation to the Burgess Health Center Foundation.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email
Daytime Phone
Donation Amount
Donation Designation
- In Memory
- In Honor
- Guardian Angel
- Area of Greatest Need
In memory or honor of whom:
Would you like us to let this person or their family know of this donation?
- No
- Yes
Honoree Address (Address not needed for Guardian Angel recipient)
Street Address Address Line 2 City State ZIP Code
Note you would like to add regarding donation:
Credit Card

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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