Request Client Services Support

If you are a qualifying individual (see below) seeking Death with Dignity, OR you are seeking support for Voluntary Stopping Eating and Drinking (VSED), please complete our form to be assigned a Volunteer Client Advisor, who will reach out to you within 1-3 business days after your form is submitted.

Who do we assist?

End of Life Washington provides client services to those who are facing the end of life and desire access to choices. We can help you manage some of the most intimate and important decisions you will ever make. Our Volunteer Client Advisors help patients explore their options for end of life. We will also provide support and guidance on Voluntarily Stopping Eating and Drinking (VSED) and to qualifying terminally-ill individuals seeking to use the Washington Death with Dignity Law. To qualify, you must be a Washington State resident over the age of 18 with a 6-month prognosis.

Begin the conversation early

We encourage you to contact End of Life Washington in the early stages of illness. This gives our volunteers time to establish a relationship and to discuss the important questions surrounding your end-of-life choices. A Volunteer Client Advisor can come to your home and talk with you at your convenience. All End of Life Washington services are free of charge.

Contact us today

Request our services by completing the form below, or call us at 206-256-1636 during our regular business hours.

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.






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



If Yes to the above question, please list the physicians willing to act as either prescribing or consulting physician.
Current Care for VSED Inquiries







Please list the names of your physicians:
[For VSED, please include the name of the physician(s) from whom you receive care:  your primary care physician 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?







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!

Contact Information

Or by mail

End of Life WA
9311 SE 36th St,
Suite 110,
Mercer Island, WA 98040

Phone: 206.256.1636

info@endoflifewa.org