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Advance Directives for Health Care
Choose the advance directive form that you prefer from the options below. Vermont does not have a required advance directive form, so you can pick the one that best meets your needs. All forms allow you to appoint a health care agent and describe your treatment preferences.
Appointment of a Health Care Agent Form
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 MoreAdvance Directive Short Form
Enables you to appoint a health care agent and provide detailed information about your health care goals and treatment priorities.
Download Form Learn MoreAdvance Directive Long Form
The original Vermont Advance Directive. 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 MorePREPARE for Your Care Advance Directive (English)
Visit the PREPARE website for easy to read advance directives developed by the PREPARE program based in California (English version). Advance Directive template are available for all 50 states, including Vermont.
Vermont Prepare FormDisability Rights Vermont Advance Directive
Produced by Disability Rights Vermont for individuals seeking to include information about mental health preferences and decisions.
Download Form Learn MoreVT Department of Disabilities, Aging and Independent Living: Appointment of a Health Care Agent
This form may be used for people who want to appoint a health care agent, but may not be able to describe detailed advance directives.
Download Form Learn MoreMedical Orders (Vermont DNR/COLST Form)
A medical order completed by your clinician to limit the use of life sustaining treatments at end of life. Based on your medical condition, your values, and your wishes.
DNR/COLST Form
Updated in June 2022, this is the most current version of the VT DNR/COLST. This is a medical order completed by your clinician with your consent, or the consent of your surrogate decision-maker. DNR/COLST stands for Do-Not-Resuscitate/Clinician Orders for Life-Sustaining Treatment
Download Form Learn MoreVermont Advance Directive Registry (VADR): Forms & Submission Instructions
Directives submitted to the VT Advance Directive Registry via mail, fax or email require the VADR Registration Agreement and Authorization to Change form. Follow instructions on the form to find out how to submit your directive to the VADR. Older versions of this form, which was previously separated into two documents (Registration Agreement form, Authorization to Change form) are still valid.
VADR Registration Agreement and Authorization to Change Form
Required when submitting new or updated documents to the VADR via mail, fax or email. NOT required for USER UPLOAD. Allows for your document to be accessed electronically by providers nationwide.
Download Form Learn MoreProvider Access to the VADR
For Vermont hospitals, accessing the VADR is a statutory responsibility. Any Vermont healthcare provider, facility, or funeral home can apply for access. To become an authorized user of the VADR, complete & submit the application form in order to receive an account.
Provider Access Application Application Overview PageJuly 1, 2024 - Updates to VADR Policies and Procedures
New submission options, website features and customer service locations have taken effect on July 1, 2024. Read more about the changes here.
Read Memo Read More (newsletter)Forms for Patient Choice & Control at End of Life (Act 39)
Physician Reporting Form
Enables a prescribing physician to document the legal steps required under Vermont's Medical Aid in Dying Law.
Download Form Learn MoreConsulting Physician Reporting Form
Enables a consulting physician to document the legal steps required under Vermont's Medical Aid in Dying Law.
Download Form Learn MorePatient Written Request for Medication Form
Enables patients to complete the written request required by Vermont's Medical Aid in Dying Law.
Download Form Learn MorePhysician Follow-Up Reporting Form
Required for prescribing physicians who write a prescription for a lethal dose of medication under Vermont's Medical Aid in Dying Law.
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