Request a Donation

WELL & Company thrives on community collaboration.
Please use this form to contact us in relation to donations or fundraiser events and our team will be in touch with you shortly!

Donation Request Form

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Contact Name*

First Last

Email*

Organization Information

Organization Name

Are you a registered charity or non-profit?*

Yes

Donation Request

Monetary Donation

Services/Items (including silent auctions)

Volunteer Opportunity

Purpose of the Donation*

Has your organization received support from WELL & Company in the past?

Yes

If so, what amount?

Will you be providing WELL & Company with an official tax receipt?

Yes

When is this event?

What is the deadline for this donation?*

Your Phone Number*

Primary & Urgent Care Clinic

Alexandria Location

Monday - Thursday	8 am - 5 pm
Friday	9 am - 4:30 pm

Extended hours and weekend appointments available to members.

St Joseph Location

Monday - Friday

9 am - 4 pm

*Closed Wednesdays

Extended hours and weekend appointments available to members.

Schedule a Medical Appointment

MedSpa

Alexandria

Monday – Friday	9 am - 5 pm
Tuesday	Extended availability

St. Joseph

Monday – Friday	9 am - 5 pm
*Closed Wednesdays

Schedule a MedSpa Appointment

hours

Request a Donation

Donation Request Form

Next Steps: Sync an Email Add-On

Primary & Urgent Care Clinic

MedSpa

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