Lakeridge Health Foundation - New Donor Online Survey

Contact Information

Name (first and last)

Address

Address 2

City/Town

State/Province

Postal Code

Preferred Email Address

Phone Number

Birthday (optional)

Select your date of birth

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

Why were you inspired to contribute to Lakeridge Health Foundation? (please check all that apply)

I received great care as a patient of Lakeridge Health

Someone close to me has been a patient at Lakeridge Health

I learned about Lakeridge Health from a volunteer or current Foundation donor

I want to contribute to the best health care available for our community

Other (please specify)

How do you prefer to receive your communications from Lakeridge Health Foundation? (check all that apply)

By regular mail

By email

By phone

In the future, I would be interested in receiving the following information and solicitations (please check all that apply)

Foundation e-Newsletter with Hospital and Foundation updates and upcoming events

Foundation fundraising letters

Information about how to donate a small amount each month, receive fewer mailings and just one tax receipt each year (monthly giving can be adjusted any time by contacting the Foundation)

Information about stock or life insurance donations

Information about endowment funds

Information about how to become a volunteer with the Foundation

Information about how to organize a community event in support of Lakeridge Health

Leaving a Lasting Legacy

Planned gifts help us deliver excellent health care every day to the thousands of patients who visit Lakeridge Health. Naming Lakeridge Health Foundation in your Will allows you to create a lasting legacy for future generations. Consult your financial advisor or lawyer for information regarding the tax breaks that can be realized.

I have named a charity as a beneficiary in my Will

I have named Lakeridge Health Foundation in my Will

Please send me information on how to leave a bequest to Lakeridge Health Foundation

I’m interested in sharing my Lakeridge Health experience with the community. Please contact me.

Yes

No

Lakeridge Health Foundation - New Donor Online Survey

Tell us a little bit about yourself. We’re here to listen!