Thank You!

Gifts to Hartford Hospital support programs and services that are vital to our community. Every gift truly makes a difference. To make a gift online, please fill out the form below. If this is a tribute gift, please note who the gift is in honor of or in memory of in the name field under the tribute section. 
 

 

Donation Information
Contributions directed to Areas of Greatest Need will provide an unrestricted gift that can put to immediate use wherever it’s needed most — including enhancing programs and services that lead to better care for every single one of our patients.
Amount:	$     *
Designation:	Women's Health Program Jefferson House Transplant Program Institute of Living Palliative Care Henry Low Heart Center Helen & Harry Gray Cancer Center Areas of Greatest Need
Additional Information (Optional)
If this gift is from a group or organization, please leave that information in the comments box. You may also leave any other information you'd like us to know about the gift in the comments.
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Anonymous:	I prefer to make this donation anonymously
Comments:
Donor Information
Title:	<Please select> Miss Mr. Mrs. Ms. Admiral Ambassador Archbishop Attorney Brother C.L.U. Capt. Cmdr. Col. Colonel Dr. Drs. Estate of Family of Father Friend Friends of General Governor Honorable Judge Lt. Lt. Col. Madam Major Master Misses MSGT. Prof. Rabbi Rev. Rev. Dr. Rev. Fr. Reverend Senator Sir Sir/Madam Sister The Honorable The	*
First name:		*
Last name:		*
Country:	Canada Greece United Kingdom United States Spain	*
Address lines:		*
City:		*
State:	<Please Select> AA AB AE AK AL AP AR AS AZ BC CA CAN CO CT CZ DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MB MD ME MH MI MN MO MP MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE PR PW QC RI SC SD SK TN TX UT VA VI VT WA WI WV WY YT	*
ZIP:		*
Phone:
Email:		*
Payment Information
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	American Express Diners Club Discover MasterCard Visa	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039	*
Card Security Code:		*
Matching Gifts (Optional)
If your employer has a matching gift program and you'd like to match your gift to Hartford Hospital, please check the box below and provide your company name.
	My company will match my gift
Company:		*
Tribute Information (Optional)
Please provide us with the name of the individual whom the gift is in memory or honor of: Unless your gift is anonymous, we will notify the individual or next of kin of your donation (we do not disclose dollar amount). Please disregard the "mail a letter on my behalf" checkbox.
Type:	in memory of in honor of	*
Name:		*
First name:
Last name:		*
	Mail a letter on my behalf	*

Please note: Hartford Hospital does not sell, trade or share a donor's personal information with any other entity, nor does Hartford Hospital send donor mailings on behalf of other organizations. Please refer to our privacy policy for more information.