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Medical City Las Colinas
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Community Service Request Form

At Medical City Las Colinas, we are committed to the care and improvement of human life. We are also committed to involvement in the communities we serve.

If you would like to request support from Medical City Las Colinas on behalf of your organization, please complete the form below and a representative will contact you.

Type of Request:


Tax-Exempt?

If Tax-Exempt, Please Include:


General Internet communication is inherently not secure. For this reason, we highly recommend that data considered confidential or private in nature not be submitted on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)