dgcenter-acp-alt price list for consumers

DOROTHY GARSKE CENTER
HEALTH CARE DIRECTIVE KITS AND ATTACHMENTS
PRICE LIST
(Effective August 1, 2002. Prices subject to change without notice.)

Basic kit…Price: $6.00 ea.
(Includes Living Will and Health Care Power of Attorney form,
instruction book, distribution log, wallet card).

Additional Family Member kit...Price: $4.00 ea.
(Includes Living Will and Health Care Power of Attorney form,
distribution log, wallet card).

Replacement Living Will and Health Care
Power of Attorney form only…Price: $3.00

Attachment to the Health Care Directive to state your wishes
should you be pregnant when your directive is in effect…Price: $1.00 ea.

Attachment to the Health Care Directive to refuse all life-sustaining
treatment because of poor current quality of life…Price: $1.00 ea.

Attachment to the Health Care Directive to disqualify
statutory surrogates…Price: $1.00 ea.

Prehospital Medical Care Directive forms kit…Price: $3.00 ea.
(Includes 2 copies of orange form, 1 orange card, & instructions).

DNR band kit…Price: $3.00 ea. May be worn if a form is also completed.
(Includes 2 bands with inserts and instructions)

To complete your order return ALL of the following items:

Your check or money order, made payable to "Dorothy Garske Center,"
for the correct amount (prices include postage)
Your order
Your complete mailing address on a label or plain piece of paper.
(We will use it for your mailing label)

Send all three items to:

Dorothy Garske Center
2140 East 5th Street, Suite 8
Tempe, AZ 85281