Referral Forms

Explore our comprehensive set of services or contact our referring provider team for more information.

Address: 200 High Park Ave., Goshen, IN 46526 Map
Physician referral line: (574) 364-2973
Emergency referral: (574) 364-1000 and ask for the on-call oncologist
Fax: (574) 364-2488

If you need assistance submitting your referral forms, please reach out to Marisa Nyikos by calling (574) 849-7812 or emailing mnyikos@goshenhealth.com.

To refer a patient
Address: 2024 Dorchester Ct, Suite 1
Phone: (574) 537-1221
Fax: (574) 537-1225
Office hours:
Monday - Wednesday from 8:30 a.m. - 4:30 p.m.
Office hours for calls only:
Thursday and Friday from 8:30 a.m. - 4:30 p.m.

If you need assistance submitting your referral forms, please reach out to Marisa Nyikos by calling (574) 849-7812 or emailing mnyikos@goshenhealth.com.

Address: 1615 Winsted Drive, Suite 1, Goshen, IN 46526 Map
Physician referral line: (574) 537-1625
Fax: (574) 537-9384

Office hours for phone calls: Monday - Thursday, 8:00 a.m. – 5:00 p.m. (closed noon to 1:00 p.m. for lunch); Friday 8:00 a.m. – 12 noon

If you need assistance submitting your referral forms, please reach out to Marisa Nyikos by calling (574) 849-7812 or emailing mnyikos@goshenhealth.com.

Address: 1855 S. Main Street, Suite A, Goshen, IN 46526 Map
Satellite location: 1033 S. Indiana Ave., Syracuse, IN 46550 Map
Satellite location: 16605 State Road 23, South Bend, IN 46635
Physician referral line: (574) 364-3921
Fax: (574) 533-7145
Office hours for phone calls:
Monday – Thursday, 8 a.m. – noon; 1 p.m. – 4:30 p.m.
Friday 8 a.m. – noon

If you need assistance submitting your referral forms, please reach out to Marisa Nyikos by calling (574) 849-7812 or emailing mnyikos@goshenhealth.com.

• HVC Cardiology Referral Form
• HVC Vascular & IR Referral Form
• HVC Cardiac Rehabilitation Referral Form
• HVC Vascular Ultrasound