Request Information

1-877-209-8086


Request Information for Health Care Professionals

NOTE: If you are a community member or non health care professional, please click here to request information.


Resources available from the West Virginia Center for End-of-Life Care.  Submit this form to request brochures, forms, and videos.


First Name: Last Name:
Credentials:  
Organization:  
Address:
City: State: Zip:
Phone#: Email Address:

Please check the box next to the resource(s) you would like to receive.  Unless otherwise noted, there is a limit of 100 of each form per request.

Advance Directives

Frequently Asked Questions Booklet about the Living Will and Medical Power of Attorney forms (includes Living Will, Medical Power of Attorney and Combined Medical Power of Attorney and Living Will forms)
LARGE Print Medical Power of Attorney, Living Will, and Combined Form
Do Not Resuscitate card
Physician Orders for Scope of Treatment form

Information about End-of-Life Care
Do Not Resuscitate brochure

Physician Orders for Scope of Treatment (POST) brochure
Palliative Care brochure
Hard Choices for Loving People booklet (Limit: 5 We can supply order form from the publisher.)
Organ Donation brochure
Hospice Services in the Nursing Home Facility brochure
Using the POST Form: Guidance for Healthcare Professionals manual
Annotated Bibliography about Outcomes with Feeding Tubes (Limit 1 - feel free to copy)
WV Joint Policy Statement on Pain Management at the End of Life (Limit 1 - feel free to copy)

"Contact us today... for those you love."