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Advance Directives for Health Care & Medical Orders
Appointment of a Health Care Agent
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
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 MorePREPARE for Your Care Advance Directive (Spanish)
Easy to read advance directive developed for Vermont by the PREPARE program based in California (Spanish 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 Order
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 MoreForms to Submit Advance Directives to Vermont's Registry
Advance Directive Registry Agreement
Required to initially submit and register your advance directive. Allows for your document to be accessed electronically by providers nationwide.
Download Form Learn MoreAdvance Directive Registry Authorization to Change
Required when submitting your updated advance directive to your existing record within the Registry.
Download Form Learn MoreForms 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.
Download Form Learn MoreLooking for an advance directive form in another language?
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).
