General Donation

Your donation will support the current equipment needs of WLMH and ultimately benefit the health care available to our community.

  1. Donor Information

  2. Donation Information

  3. Payment Information

  4. $0.00
  5. 3-digit value located on back
  6. Miscellaneous

  7. Confidentiality

    I understand that West Lincoln Memorial Hospital Foundation Inc. will keep my donation information I provided here confidential and agree that the Foundation may forward information or requests for donations in the future.