Havasu Community Health Foundation
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Havasu Community Health Foundation

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filler@godaddy.com

  • Home
  • Arizona Tax Credit
  • Events
  • Programs
  • Tribute Giving
  • Veterans'

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In-Office Transactions

Contributions (2)

Contributions - Tribute Giving

Data Entry Form

Events (3)

Events & Sponsorship - Merchandise - Ticket Sales. Multiple Registrant

Data Entry Form

Food Bank (4)

Food Bank

Data Entry Form

Giving Funds (5)

A donor-advised fund (DAF) - A Charitable Trust - Anonymous Giving - CRT

Data Entry Form

Labs & Screenings (6)

Low-Cost Labs and Screening Program

Data Entry Form

Tax Credit (7)

Arizona Tax Credit Program

Data Entry Form

Veterans' (8)

Housing - Stonebridge

Data Entry Form

In Office Transaction Forms

2 Contribution Form (pdf)Download
2 Tribute Giving Form (pdf)Download
3 Events Form (pdf)Download
3 Merchandise Form (pdf)Download
3 Multiple Registrant (pdf)Download
3 Ticket Form (pdf)Download
4 Food Bank Form (pdf)Download
5 Anonymous Giving Form (pdf)Download
5 Giving Funds Form (pdf)Download
7 Tax Credit Form (pdf)Download
8 Veterans Housing Form (pdf)Download
8 Veterans Stonebridge Form (pdf)Download

Labs and Screenings Form

6 Application Cancer (pdf)Download
6 Application Comp (pdf)Download
6 Application Labs (pdf)Download
6 Application Medical (pdf)Download
6 Application Wig (pdf)Download
6 Application Xray (pdf)Download

Acknowledgment Letters Downloads

Contribution Acknowledgment (docx)Download
Events Acknowledgment (docx)Download
Food Bank Acknowledgment (docx)Download
Giving Fund Acknowledgment (docx)Download
Labs Screenings Acknowledgment (docx)Download
Merchandise Acknowledgment (docx)Download
Stonebridge Acknowledgment (docx)Download
Tax Credit Acknowledgment (docx)Download
Tickets Acknowledgment (docx)Download
Tribute Giving Acknowledgment (docx)Download
Veterans Housing Acknowledgment (docx)Download

HCHF In Office Forms

Advertising Articles (pdf)Download
Cancelled Refund (pdf)Download
Cash Bank (pdf)Download
Credit Card Authorization (pdf)Download
Credit Card Authorization Backup (pdf)Download
CRT Follow-up (pdf)Download
CRT Follow-up (docx)Download
Data Corrections:Request (pdf)Download

Frequently Asked Questions

A frequently asked questions list is often used where common questions tend to recur from changes to the system or by new users related to common knowledge gaps. We'll update the Q&As to keep everyone informed.

After visiting your Health Care provider and receiving a Physician's Order, bring the printed order and your identification (I.D.) with you to the Havasu Community Health Foundation at 2126 McCulloch Blvd. N Suite #14. 


Here's a current list including cost. Labs/Screening


Cash - Check

Credit Card (requires a 4% processing fee)


Nonprofit charitable foundations sometimes ask for extra money to cover charges to ensure that the total amount of the intended donation goes toward the charitable cause rather than being eaten up by transaction fees or administrative costs.


Our forms are web-based and must be accessed on a web browser. Unfortunately, web browsers do not communicate with mobile credit card swipers. Specifically on iPhones & iPads, Apple's iOS disables the web browser's ability to 'talk' through the headphone jack to swipe devices. This is a deliberate move by Apple to control how money is transacted on their devices, directing all transactions through the App Store or through apps already purchased on the App Store.


Your business must first be a licensed medical practice to accept HSA or FSA cards. Fortunately, specialized equipment isn't needed to accept HSA or FSA cards. Instead, any credit card machine can take these cards as long as they are PCI compliant (to comply with HIPAA requirements of electronic health care transactions and security).


The survey will be used as a benchmark to compare future results and track changes over months and years. The objective is to determine returning Participants, how the community is made aware of the low-cost labs and screenings program, and how the results are used to highlight trends.


A doctor's order is required to perform the proper tests. It prevents unnecessary or irrelevant tests, saving you time and resources. 


The discounted rates for labs and screenings are available for unlimited use. 


Vendors and participants can register online at our website, www.havasucommunityhealthfoundation.org. Under events, there should be a link for vendors and participants. For walk-ins in the office, we take cash or checks.


Participants can go to our website, www.havasucommunityhealthfoundation.org, and click the link to community resources. The application can be downloaded and filled out online or turned in at the office.


Food Bank hours are: 

Monday, Tuesday, Thursday, and Friday from 10 am -1 pm

Food Donation Hours: Monday, Tuesday, Thursday, and Friday, 7 am – 1 pm


Yes, they can go to www.havasucommunityhealthfoundation.org and click on the Arizona tax credit link, and on the left, it has a link that says tax credit form.  


The maximum QCO credit donation amount for 2024: $470 single, married filing separate or head of household; $938 married filing joint. Refer to AZ Department of Revenue https://azdor.gov/individuals/income-tax-filing-assistance/tax-credits


Participants need to show proof from a doctor's office that they were Cancer Patients or survivors within the last two years.


Changes to any In-Office or Data Entry Forms

Contact Information

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Data Entry & In-Office Forms Only

NOT FOR DATA ENTRY CORRECTIONS


Labs and Screenings Cash/Checks

LS Comp Cash/Checks or Credit


AZ Tax Credit Cash/Checks or Credit

Contributions Cash/Checks or Credit

Donation & Merchandise Cash/Check or Credit

Rental Properties Cash/Checks or Credit

Sleepless in Havasu Cash/Checks or Credit

Tribute Giving Cash/Check or Credit


OTHERS:

Cancelled/Refund

Cancer Gas Reimbursement

Havasu Community Health Foundation

2126 McCulloch Blvd N Suite 14, Lake Havasu City, Arizona 86403, United States

admin@havasuhealthfoundation.org office@havasuhealthfoundation.org

Copyright © 2025 HCHF - All Rights Reserved.

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