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Provider Quick Guide

Download our comprehensive guide on everything you need to know when referring patients to Goshen Health for services.

Download Guide Referral Support

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Get the Care You Need

At Goshen Health, we strive to provide our patients with exceptional care and support throughout their healthcare journey. Experience the difference at Goshen Health as a patient.

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Visitor Resources

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View Our Visiting Hours, Guidelines and More

Visitor Information

Business Health Advantage

We aim to help employers stabilize healthcare costs, attract, retain, and recruit a talented workforce, while creating a culture of wellness.

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Start Here. Grow Here. Stay Here.

Goshen Health is a place where you can constantly grow as a healthcare professional amongst a team that cares about you.

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When you include Goshen Health Foundation in your estate plan, your generosity improves the health of our communities by helping provide innovative, outstanding care.

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Find documents you need including forms, policies or procedure.

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Park Bench Fitness Participant Survey

Park Bench Fitness Participant Survey

Please provide your feedback on the Park Bench Fitness program. All questions are optional and responses are confidential.

Park Site

How often do you engage in at least 30 minutes of moderate physical activity each week?

The Park Bench Fitness videos were easy to understand

I enjoyed the exercise videos

I would recommend these exercise videos to a friend or family member

I plan to do these exercises again

The videos helped make exercise more accessible

The videos helped me to exercise more than I usually do

Do you have any suggestions for improvement or additions to the program?

Age

Gender

Are you Hispanic or Latino?

Race

If you answered 'Other' under Race, please explain

Are you a new or existing patient?

New Existing

*Note: Some offices may require a referral to schedule an appointment.

First Name

Last Name

Address

Address 2

City

State

Zip Code

Phone

Date of Birth (MM/DD/YYYY)

Is this a minor child?

Name of responsible party

Relationship to minor child

Date of birth for responsible party (MM/DD/YYYY)

Preferred language, if other than English

Preferred other language

Insurance Coverage? NoYes

Insurance Carrier Name

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