Rapid Self-Referral Form

We can help you become a patient at Goshen Center for Cancer Care. We can usually schedule an appointment in a matter of days. Simply fill out the self-referral form below or call our Cancer Care Help Line at (888) 492-HOPE.
 

Connect with an information specialist

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.

Goshen Center for Cancer Care

Goshen Center for Cancer Care
200 High Park Ave.
Goshen, IN 46526
888-492-HOPE(4673)
 

Emergency Services

Available 24/7 at Goshen Hospital.

Patient Financial Services/Financial Assistance

(574) 364-2420

Contact our Financial Advocate for information about financial assistance and payment plan options.

General Inquiries

Call (574) 364-1000 for general information.