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)
Frequently Asked Questions Booklet - Large Print for the Visually Impaired (same as above but with larger print)*
Do Not Resuscitate card
Physician Orders for Scope of Treatment form

Information about End-of-Life Care
Do Not Resuscitate brochure
Palliative Care brochure
Hard Choices for Loving People booklet (Limit: 10)
Organ Donation brochure
Physician Orders for Scope of Treatment (POST) brochure
Physician Orders for Scope of Treatment (POST) brochure for patients and families
Hospice Services in the Nursing Home Facility brochure
Using the POST Form: Guidance for Healthcare Professionals manual
Annotated Bibliography about Outcomes with Feeding Tubes*
West Virginia Joint Policy Statement on Pain Management at the End of Life*

*Limit 1.  You are welcome to make photocopies.

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