S. VT. Wayfinders Contact

The Comfort Project: Contact Form and Client Information Sheet

To contact the Comfort Project, please submit the following form.

Please note: Vermont doctors are generally scheduling appointments for out-of-state patients who are interested in Medical Aid in Dying only after they have documentation from a medical provider of a life expectancy of 6 months or less. Be aware that Vermont doctors are booking out about two months for first appointments. If you are looking for general information about Medical Aid in Dying please review the Patient Choices Vermont website: https://www.patientchoices.org/

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Your Name: *

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Your Email Address: *

Your Phone Number: *

Patient Name (if different from above) *

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Patient Street Address *

Patient State of Residence: *

Patient Zip Code *

Patient City or Town: *

Patient Email (if different from above): *

Is the patient currently enrolled in hospice? *

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If yes, please provide name of hospice. *

Patient Phone Number (if different from above): *

Please describe how we can help. Be as specific as you can. Thank you. *

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