GoldenCare Membership Application

Join GoldenCare Today!

Please fill out and submit this application to join GoldenCare. Don't forget to fill out a membership form for your spouse or significant other.

First Name *

Last Name *

Email Address *

Address *

Address 2

City *

State *

ZIP *

Phone *

Birth Date *

I have read the Notice of Privacy Practices. *

address3

senior woman taking water aerobics class

GoldenCare Membership Benefits

GoldenCare is a free program available to Wisconsin residents 60 years of age and older. You do not have to be a patient at SSM Health SSM Health Dean Medical Group to take advantage of the many benefits and discounts of GoldenCare senior membership.

Apply online or in-person at the GoldenCare office at SSM Health St. Clare Hospital - Baraboo to sign up.

After you submit the form you’ll receive your GoldenCare membership card in the mail, and you can start taking advantage of the program benefits right away.

Do you have questions about the program?

We’re here to help answer any question you may have about the GoldenCare program. For more information or help filling out the application, simply call 608-356-1407.