Request Client Services Support

If you are a qualifying individual 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 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. 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.

Begin the conversation early

We recommend contacting End of Life Washington soon after receiving a prognosis of six months or less. 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 may be able to come to your home and talk with you. All End of Life Washington services are provided at no cost to clients. We are funded and able to provide these services thanks to the generosity of individual donors. If you would like to donate to help fund and sustain Washingtonians’ access to our services, you can do so here.

We understand that some requests are urgent, and we cannot guarantee volunteer services within three business days of a support request being made.

Contact us today

Request our services by completing the form below. If you are unable to complete the form, call us at 206-256-1636 during our regular business hours. Once you have completed the form, a volunteer will usually reach out within 3 business days. After submitting the form, you will receive an email confirming that we have your request.

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 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?







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
931600-B SW Dash Point Road #1272
Federal Way, WA 98023

Phone: 206.256.1636

info@endoflifewa.org