Donation Form

Donation

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$500

$250

$100

I would like to dedicate this donation

Contact Information

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Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $0.00 to go to the Ohio Professionals Health Program and I will donate $0.00.No. I will donate $0.00 and the Ohio Professionals Health Program will cover the processing costs.

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Same As Above

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Contact Us: Ohio Professionals Health Program •• 130 E. Chestnut Street; Suite 200 •• 614-841-9690 •• [email protected]