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.

Create an Advance Directive | Change an Advance Directive


As of July 1, 2024, the Vermont Advance Directive Registry policies and submission procedures have been updated. The changes are reflected in these instructions. You can also read the memo describing the updates
 

Create and Register an Advance Directive

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

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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

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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.

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Advance Directive Forms in Other Languages

All Languages

including:

العربية / Arabic | Bosnian | မြန်မာစာ / Burmese | Chinese | Farsi | Français / French | Kirundi | नेपाली / Nepali | Soomaali / Somali | Español / Spanish | Swahili | Tiếng Việt / Vietnamese 

2. Complete the Combined Registration Agreement & Change Form

The Vermont Advance Directive Registry's (VADR) Combined Registration Agreement & Change Form gives the Registry permission to create your account and to share copies of your document with authorized healthcare professionals when needed. If you are submitting your document for registration or update via mail, fax, or email, please complete the VADR Registration Agreement/Authorization to Change form and include it with the copy of your directive that you submit.  

How do I know if I should complete the Registration Agreement or the Authorization to Change section? Learn about this choice.

If you are submitting your document via user upload on the VADR website, this Combined Registration Agreement & Change Form is not required. You will give permission for account creation and document access online.
Learn about user upload

 

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:

Change Your Advance Directive

Access your registered advance directive

You can log into your personal account with the username and password you created when you set up your registry account OR refer to the login instructions on your most recent letter from the registry. 

Personal Account Login

You can use your personal account to:

  • Download, view and print your document(s).
  • Email or fax a copy of your document.
  • Confirm that your document is current and still reflects your wishes.

Make changes to your advance directive

  1. Complete a new advance directive form. The new advance directive must be signed and witnessed. In addition to submitting your new directive to the Registry, send copies of the new directive to anyone with a copy of your previous advance directive. 
  2. Email, mail or fax a copy of the newly signed advance directive form AND an Authorization to Change form* to:

*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. 

Revoke the appointment of a health care agent, suspend or delete your advance directive

  1. Submit a written statement and a signed Authorization to Change form to the Vermont Advance Directive Registry. Provide a copy of the written statement to anyone with a copy of your advance directive.
  2. Mail or fax the written statement and form to:
  • Mail: Vermont Advance Directive Registry, P.O. Box 2789, Westfield, NJ 07091-2789
  • Fax: (908) 654-1919

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