Donate Today and Help Change Lives!

Donate Now

Donate Online Today and Help Change Lives!

Your donation is making a difference in the innovative treatment we provide in our communities.

Every dollar you give to Pacific Clinics goes towards helping administer behavioral healthcare services to consumers throughout five counties in Southern California.

Make a difference by: 1. Filling out the secure donation form on PayPal below 2. Sending your check payable to Pacific Clinics and mailing it to: Pacific Clinics Public Affairs 800 S. Santa Anita Ave, Suite 300 Arcadia, California 91006

Contact Information:

First Name:	Last Name:
Address 1:
Address 2:
City:	State: Zip:
Email:	Home Phone:

I would like to designate my donation as a:

General Donation (where it is needed most)

Consumer Activities and Resources (C.A.R.E.) Fund Gift

Housing Services Gift

Memorial Gift

Honor Gift

Western Avenue Renovation Project (Portals Foundation, Inc.)

In the amount of:

$250

$100

$75

$50

Other

Who would you like to memorialize?

Who would you like to honor?

First Name: Middle Initial: last Name:

Would you like to send a personalized memorial card notifying them of your thoughtful donation?

Yes

Who would you like to send your card to?

First Name *:	Last Name:
Address 1 *:
Address 2:
City *:	State (US only): Zip:
Country:
Telephone

Your personalized message will be printed on 6 lines as you type below. Each line has a 35 character limit (including spaces and punctuation).

1 *
2
3
4
5
6	Signature