Donor Consent for Philanthropy Office Assistance

Dear Donor,  

Thank you for your major philanthropic investment in quality care at Lahey Clinic.

The Philanthropy Office is available to help our generous benefactors navigate the Clinic. Health ambassador appointment assistance is available at, and above, the $10,000+ senior membership level of the Chairman's Council.

Please complete and return the attached consent form to allow your liaison in the Philanthropy Office

  • to view and access your medical appointments and demographic information for the purpose of assisting you to schedule appointments;
  • to access physicians and other medical personnel on your behalf;
  • to assist with referrals;
  • to visit you in the Clinic when present for appointments; and
  • to provide you with other general navigational assistance at the Clinic.

Completed and signed donor consent forms must be faxed or mailed to: Philanthropy Office; Lahey Clinic; 41 Mall Road; Burlington, MA 01805; Phone: 781-744-3333; Fax: 781-744-5265;