Online Donations 
 
Thank you for your support. Please complete the following information. Then click the submit button on the bottom right of the page to complete your donation via PayPal. You may also call the clinic at (954)563-9876 to make your donation by phone.
Title
First Name*
Last Name*
Email*
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Amount of donation*
$25
$50
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$250
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$1000
Other Amount
I would like to make this donation One time  Monthly Recurring
I would like this donation to be used for
Designation
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