Create and Register An Advance Directive

Create and Register An Advance Directive

An advance directive is a written document that outlines your wishes for medical treatment in the future, including if you are no longer able to make those decisions. The State of Vermont contracts with the Vermont Ethics Network to provide education and support for advance care planning and customer support for the Vermont Advance Directive Registry. Registration is free.

1. Complete and sign an advance directive form

Click on the form types below to learn more about and download the forms. You can also choose one from another organization of your choice. Vermont law does not favor one over another. If you already have an advance directive, please go to step 2.

Please note: Vermont advance directives require the signature of two adult witnesses. Witnesses cannot be your appointed health care agent, spouse, siblings, parents, children or grandchildren. 

Appointment of a Health Care Agent Form

Take the first step in advance care planning by appointing a health care agent and providing some general guidance about your health care goals.

Health care agent form

Advance Directive - Short Form

The form includes five (5) sections on:
•    Appointment of My Health Care Agent
•    Health Care Goals and Spiritual Wishes
•    Limitations of Treatment
•    Organ/Tissue Donation and Burial/Disposition of Remains
•    Signed Declaration of Wishes

If you would like to skip a section of the form, please draw a line through it but do not remove any pages.

Short-Form Advance Directive

Advance Directive - Long Form

This form includes nine (9) sections on:
•    Appointment of My Health Care Agent
•    Others Who Are or May Become Involved in My Care
•    Statement of Values and Goals
•    End-of-Life Treatment Wishes
•    Other Treatment Wishes
•    Waiver of Right to Request or Object to Future Treatment
•    Organ and Tissue Donation
•    Wishes for Disposition of my Body after my Death
•    Signed Declaration of Wishes

If you would like to skip a section of the form, please draw a line through it but do not remove any pages. This form may be used to include additional directions regarding psychiatric treatment and medications.

Long-form advance directive

Other Advance Directive Forms

Disability Rights Vermont
This form may be used to include additional directions regarding psychiatric treatment and medications.

Vermont Department of Disabilities, Aging & Independent Living
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.

2. Complete the Combined registration agreement & Change form

The Vermont Advance Directive Registry's Combined Registration Agreement & Change Form gives the registry permission to send a copy of your advance directive and emergency contact information to those authorized to have access. To register an existing advance directive, please fill out the Combined Registration Agreement & Change Form and return both documents to the registry. Learn more on completing this form

combined registration agreement & change form

3. SUBMIT YOUR advance directive FOR REGISTRATION

Registering a copy of your advance directive is free for Vermont residents. The Vermont Advance Directive Registry (VADR) is a secure online database that is part of the national US Living Will Registry. Registering a copy of your advance directive allows authorized health care facilities and providers quick access when it is most needed. You are not required by law to register a copy of your advance directive.

To register, submit a signed copy of your advance directive with your Combined Registration Agreement & Change Form to the Vermont Advance Directive Registry. Submissions that do not include both forms will be returned by mail for correction. You are not required by law to register an advance directive. However, registered directives give hospitals and other health care providers quick access to them in an emergency.

Return a copy of your advance directive and Combined Registration Agreement & Change Form by email, mail or fax:

Privacy Statement

The Vermont Advance Directive Registry is sensitive to the privacy of registrants, the confidentiality of their information and the documents stored for them.

The registry will provide identifying information, emergency contact information, and an exact copy of the advance directive, provided by the registrant, to any provider with a valid request that complies with the policies and procedures of the registry.

Information transmitted via the internet to your provider or healthcare facility is encrypted and secure.

Questions and Assistance

Vermont Ethics Network
For general information, to request forms or updated stickers for your ID, help with completing an advance directive or form, or about medical decision making:
[email protected]
(802) 828-2909 (Monday to Friday, 9:00 am – 5:00 PM)

U.S. Living Will Registry
For help with your existing account, or to reset your username or password:
[email protected]
(888) 548-9455 (Monday to Friday, 9:00 am – 5:00 PM)

New Wallet ID Cards are automatically sent out ONLY if you have changed your name, primary emergency contact, or date of birth. You will not automatically get a new card for other updates. Order a new wallet card for $5 fee