Request Client Services Support

If you are a qualifying individual seeking Medical Aid in Dying (MAiD)/Death with Dignity (DWD), OR you are seeking support for Voluntary Stopping Eating and Drinking (VSED), please complete our form to be assigned a Volunteer Client Advisor. One of our volunteers will reach out to you within 3-5 business days after your form is submitted. After submitting the form, you will receive an email confirming that we have your request. Please check your spam/junk folder if you don’t see it. If you need assistance completing the form, call us at 206-256-1636 during our regular business hours. We understand some requests are urgent, but it can take up to 5 days to be connected with a volunteer. Please indicate on the intake if your request is urgent. We appreciate your patience. 

While you are waiting to have a volunteer assigned, we recommend that you ask your medical providers to provide a hospice referral. You should also ask your medical and hospice providers whether they will participate in Medical Aid in Dying/Death with Dignity.

What we do

End of Life Washington provides client services to those who are facing the end of life and desire access to choices. Our Volunteer Client Advisors help patients explore their options for end of life. We provide support and guidance on Medical Aid in Dying/Death with Dignity and Voluntarily Stopping Eating and Drinking (VSED) to qualifying individuals. A Volunteer Client Advisor can help guide you through the MAiD or VSED process. If you would like to donate to help fund and sustain Washingtonians’ access to our services, you can do so here.

Fill Out our Client Support Request Form:

Support Request for Client Services

If you need assistance filling out this form, please call us at 206-256-1636 
Information of Person Completing this Form







Client Contact Information






















Current Care & Diagnosis for DWD Inquiries








Please limit responses to 255 characters or less.







If Yes to the above question, please list the providers willing to act as either the prescribing or consulting provider.





Please list the names of your additional providers:
[For Medical Aid in Dying, include the name of the provider to whom you made your first oral request, as well as your primary care provider and any specialists familiar with your disease and its prognosis.]





Current Care for VSED Inquiries






Please limit responses to 255 characters or less.


Please list the names of your providers:
[For VSED, please include the name of the provider(s) from whom you receive care:  your primary care provider and any specialists familiar with your diagnosed illness and its prognosis.]







Additional Contacts & Information
Please include names of anyone with whom we have permission to discuss your care with.






Who should be the primary contact for this inquiry?






Are You Interested in Sharing Your Story?
We are looking for stories to share with our supporters. This will have no impact on the care you receive. We share stories on a variety of platforms, including online and print newsletters, fundraising appeals, action alerts, and social media. 

Release of Liability and Hold Harmless Agreement for End of Life Washington
1. I UNDERSTAND THAT THE VOLUNTEER CLIENT ADVISORS PROVIDED TO ME BY END OF LIFE WASHINGTON (“EOLWA”) ARE NOT EMPLOYED OR CONTRACTED BY EOLWA BUT ARE VOLUNTEERING THEIR TIME TO ME FREE OF CHARGE. I ALSO UNDERSTAND THAT ANY MEDICAL PERSONNEL REFERRED TO ME BY EOLWA ARE NOT EMPLOYED BY EOLWA AND EOLWA DOES NOT COMPENSATE THEM IN ANY WAY OR RECEIVE ANY BENEFIT FROM SAID PERSONNEL.

2. FOR THE FREE SERVICES I RECEIVE FROM EOLWA, I AGREE TO RELEASE AND HOLD HARMLESS FROM LIABILITY AND DAMAGES EOLWA, ITS EMPLOYEES, VOLUNTEERS, AND MEDICAL PERSONNEL REFERRED TO ME BY EOLWA FOR ANY ACTIONS UNDERTAKEN BY ANY OF THE ABOVE ON MY BEHALF.

Please review this form carefully and be sure that your information is accurate and complete.  Fields marked with an asterisk are required. You will be sent a confirmation email - check your inbox.  A volunteer will be in touch within three business days.  Thank You!

End of Life Washington shares de-identified data about its clients with the American Clinicians Academy on Medical Aid in Dying for the purposes of collecting observational data about the Medical Aid in Dying process and outcomes, with a goal of continual improvement in patient care. Your privacy and confidentiality are important and only anonymized data will be utilized for this purpose. Directly identifying information (e.g. names, addresses) will be maintained only by End of Life Washington and is never shared with any other organizations. Please let us know if you have concerns or questions. 

Or by mail

End of Life WA
1600-B SW Dash Point Road #1272
Federal Way, WA 98023

Phone: 206.256.1636

info@endoflifewa.org