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If this is a medical emergency please call 911 immediately. Please do not include personal medical information on this form.
We respect your privacy.
The information that you provide via this website will be strictly confidential and is intended only for the use of Goshen Health in providing care and services to you.
200 High Park Ave.
(Located off Main Street/State Road 15)
Goshen, IN 46526
Available 24/7 at Goshen Hospital.
Contact our Financial Advocate for information about financial assistance and payment plan options.
Call (574) 364-1000 for general information.