NHDD 2023: Start planning today! Vermont Advance Directive Week: April 9-16 | National Health Care Decisions Day: April 16
It appears you're using Mirosoft Internet Explorer or an early version of Edge. To fully enjoy this website — and pretty much every modern website in existence — we suggest you upgrade to Chrome or Firefox. You'll be happier.
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
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 More
Easy to read advance directive developed for Vermont by the PREPARE program based in California (English 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
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 More
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 More
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.
Required when submitting new or updated documents to the VADR. Allows for your document to be accessed electronically by providers nationwide.Download Form Learn More
Instructions to e-mail your advance directive to the Vermont Advance Directive Registry.Download Instructions Learn More
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 Page
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
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 More