No specific form is required. You can have an attorney prepare an advance directive for you or you can do it yourself using one of these forms.
We offer a long form and a short form. The short form is simpler. It covers the basic information about who can decide about your health care. It also lets you decide what you want your providers to do in a medical emergency. The long form lets you give more detailed instructions. It asks you for more details about what medical treatment you want.
Use our Advance Directive for Health Care short form (three pages).
- Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, use the web page version of our Advance Directive short form.
- Use the PDF version of the Advance Directive short form.
Or use our Advance Directive for Health Care long form (11 pages).
- Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, use the web page version of our Advance Directive long form.
- Use the PDF version of the Advance Directive long form.
If you want to, you can send your advance directive form and the Vermont Advance Directive Registry agreement form to the Vermont Advance Directive Registry. They will store it in a secure electronic database so that hospitals or other providers will have quick access to it in an emergency. Registration is free for Vermonters.
Keep a copy of the advance directive for yourself, your agent and your family. Then mail or fax the form to:
Vermont Advance Directive Registry
PO Box 2789
Westfield, NJ 07091
Fax: 908-654-1919
