Financial Assistance

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 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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