Find a provider
The Academy’s referral system connects patients to clinicians who provide aid-in-dying care.

Navigating the healthcare system to find providers who can support and guide you and your loved ones through the aid-in-dying process can be unexpectedly complicated. The Academy is here to provide you with the necessary information and referrals.
Essential Information for Patients and Families.
If you have been diagnosed with a terminal illness, can make your own medical decisions, and are interested in being evaluated for medical aid in dying, please read the details below and then fill out the intake form at the bottom of this page; patients may require assistance.
While we do not provide direct patient care, we support patients by providing information and connecting them to clinicians in their area who can evaluate them for medical aid in dying. Once we receive the completed form below, we will email a response within 48-72 hours. We may need more information, so please check your emails.
Please keep in mind that verifying eligibility may take considerably longer than the minimum waiting period, and urgent requests are not easily accommodated. If you think you may want this option at some point in your dying process, we encourage you to start the eligibility process early to ensure you will have the option available.
Once we have all the necessary information, we will forward the patient intake form with contact information directly to clinicians. The clinicians then contact the patient directly. Per our agreements with providers, we do not publicly share their contact information.
Please pay close attention to the details of the questions below and answer as completely as possible. Fill in all the required fields marked with *. If the form is completed and submitted correctly, you will be taken to a confirmation page. If you complete this form and are NOT taken to the confirmation page, you have left one or more required fields * blank, and we will not receive your form. Please go back, fill in all the missing fields, and submit the form until you land on the confirmation page.