Application for financial assistance. Please print, fill out and mail or fax your completed application to the address below for review and consideration.
Financial Assistance Application
Additional information regarding financial assistance
Mail or fax your application to:
Goshen Hospital
Attn: Financial Advocate
200 High Park Avenue
Goshen, IN 46526
Phone: (574) 364-2607
Fax: (574) 364-2436
Goshen Surgery Center also offers financial assistance through Carecredit.com using either of the following options:
For questions regarding Goshen Surgery Center financial assistance or in-house payment agreements, please call (574) 364-4736 or (574) 364-4734.
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