Goshen Health | Goshenhealth.com

Request an Advance Care Planning Appointment

Complete the form below to request an appointment with an Honoring Choices Facilitator.

Contact Us Form Ignore first form field. First Name Last Name Email (Required) Phone Address 1 Address 2 City State ZIP Preferred appointment time

Morning

Afternoon

Evening

No preference

Do you have internet access and a device with video and audio capabilities?

Yes
No
It is important to have a family member or close friend, that will be involved with your health care decisions, attend the appointment. Please enter their name and relationship to you.Do you need a interpreter?

Yes
No
If so, please enter the language. We will do our best to accommodate your needs.

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.

Advance care planning is for adults of all ages

Receive the medical care you want and ensure your loved ones know your wishes.
In the appointment, we’ll help you:

Create an advance care plan
Complete advance directives
Designate a health care representative

Invite a family member or close friend

Note, it is important to have a family member or close friend that will be involved with your health care decisions attend the appointment.

Where: Virtual appointment via Zoom
Cost: Free, but an appointment is required
Questions: Call (574) 364-2288

Documents for end-of-life care

Written documents give clear instructions about the kind of care you want at the end of life. By writing down your wishes, you can help your loved ones and doctors understand and follow your choices. That’s important if you are unable to make decisions or communicate for yourself.