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.

Self Referral Form Who are you seeking cancer care for?





Please, do NOT hit the submit button more than once to allow for processing time.

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.