Coronavirus Update: Ethics Considerations, Guidance and Resources.
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Available forms to appoint a health care agent, specify care and treatment preferences, submit documents to Vermont's Advance Directive Registry, and related to Vermont's law on medical aid in dying.
Upon download of a form, please save a blank copy to your computer prior to filling it out to ensure that your information is retained.
Enables you to appoint a health care agent who will be authorized to make medical decisions for you if you are unable to speak for yourself.Download Form Learn More
Enables you to appoint a health care agent and provide detailed information about your health care goals and treatment priorities.Download Form Learn More
Enables you to appoint a health care agent, provide detailed instructions about your care, and includes provisions for those with mental health and/or psychiatric considerations.Download Form Learn More
Easy to read advance directive developed for Vermont by the PREPARE program based in California (English version).Download Form Learn More
Easy to read advance directive developed for Vermont by the PREPARE program based in California (Spanish version).Download Form Learn More
Produced by Disability Rights Vermont for individuals seeking to include information about mental health preferences and decisions.Download Form Learn More
Required to initially submit and register your advance directive. Allows for your document to be accessed electronically by providers nationwide.Download Form Learn More
Required when submitting your updated advance directive to your existing record within the Registry.Download Form Learn More
Enables a prescribing physician to document the legal steps required under Vermont's Medical Aid in Dying Law.Download Form Learn More
Enables a consulting physician to document the legal steps required under Vermont's Medical Aid in Dying Law.Download Form Learn More
Enables patients to complete the written request required by Vermont's Medical Aid in Dying Law.Download Form Learn More
For individuals seeking advance directive forms in the following languages, you may use California’s PREPARE for Your Care form so long as you follow Vermont’s witnessing requirements (i.e. for outpatients: 2 witnesses who are not immediate family members; and for individuals being admitted or in a nursing home or hospital—adding in the “explainer” witness signature).