11/23/24

Donation Form Hero Banner - A mom outdoors spinning in circles with a young girl near 5 years of age and their foreheads are pressed against each other's forehead while smiling

Support HSS Rheumatology

Your gifts help support groundbreaking research initiatives that promise to bring knowledge, hope, and treatment options to patients and families. Join us by making a gift to support HSS Rheumatology.

If you have any questions about making your gift, please call 212-606-1196. If you would like to give through your donor advised fund, or to make a gift via stock or wire transfer, please click here for instructions.

Required Asterisk Example = Required fields

Select Gift Amount:

Yes, automatically repeat this gift every month.

Honor/Memorial Information

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Personal Message:

Postal Notification

Please send a notification via the postal mail.

Full Name:

Street Address:

Apt/Box/Unit/Suite:

City:

State/Province:

ZIP/Postal Code:

Personal Message Closing (e.g. Yours Truly, Respectfully, Sincerely, etc.):

Personal Message Signature (e.g. John Smith, The Smith Family, Mr. & Mrs. Smith, etc.):

Yes, please include the gift amount in the notification personal message.

Billing Information

Title:

First Name:

Last Name:

Suffix:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Yes, I'd like to receive email updates from Hospital for Special Surgery.

Payment Information

Payment Method:

Credit CardBank Account Withdrawal

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Bank Account Information:

Bank Routing Number: What is this?

Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

I agree to use my bank account as a payment method and authorize Hospital for Special Surgery to debit my bank account to fulfill my donation commitment.

Support HSS Rheumatology

Honor/Memorial Information

Billing Information

Payment Information

Payment Method:

Credit Card Information:

Bank Account Information:

Check Information

Connect With Us

Learn More

Information For

Policies