Letter of Intention

The information you provide here about your legacy gift for Mount Sinai will ensure that our records are accurate and that your gift is designated to your intentions. All information and/or documentation of your estate plan that you provide will be kept confidential. This is not a legally binding document. If you have any questions, please contact at plannedgiving@mountsinai.org or 212-659-8500.

Confidential Information Form

Please confirm your contact information:

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Gift information

I/We have included Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai/New York Eye and Ear (add in other subsidiary institutions) as a beneficiary of my/our:


Is this gift revocable or irrevocable?


Is this a percentage or a specified amount?


Please tell us about your gift designation. (Please select all that apply.)




The Mount Sinai Health System recognizes our legacy donors with membership in the Legacy Society. By listing your name as part of this group in our publications, we hope you will inspire others to create their own legacy with us. Please indicate if you would like to be listed, or if you prefer to remain anonymous.


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