NHDD 2023:
Start planning today! Vermont Advance Directive Week: April 9-16 | National Health Care Decisions Day: April 16
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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.
Advance Directives for Health Care & Medical Orders
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
NEW Interactive PDF! 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)
Easy to read advance directive developed for Vermont by the PREPARE program based in California (English version).
Download Form Learn MoreDisability Rights Vermont Advance Directive
Produced by Disability Rights Vermont for individuals seeking to include information about mental health preferences and decisions.
Download Form Learn MoreDNR/COLST Form (NEW! 2022 Updated Form)
Effective June 1, 2022. 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.
Download Form Learn MoreVT Department of Disabilities, Aging and Independent Living: Appointment of a Health Care Agent
This form may be used for people with developmental disabilities who want to appoint a health care agent, but may not be able to describe detailed advance directives.
Download Form Learn MoreVermont Advance Directive Registry (VADR): Forms & Submission Instructions
All submissions to the VT Advance Directive Registry 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. Allows for your document to be accessed electronically by providers nationwide.
Download Form Learn MoreVADR Electronic Submission Instructions
Instructions to e-mail your advance directive to the Vermont Advance Directive Registry.
Download Instructions Learn MoreProvider Access to the VADR
For health care providers, accessing the VADR is a statutory responsibility. To become an authorized user of the VADR, complete & submit the application form in order to receive your access information.
Provider Access Application Application Overview PageForms for Patient Choice & Control at End of Life (Act 39)
Physician Reporting
Enables a prescribing physician to document the legal steps required under Vermont's Medical Aid in Dying Law.
Download Form Learn MoreConsulting Physician Reporting
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
Enables patients to complete the written request required by Vermont's Medical Aid in Dying Law.
Download Form Learn MorePhysician Follow-Up Reporting
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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