Create and Register An Advance Directive

Older woman assists younger woman with important papers

Ensure that your critical health care decisions will be honored by creating and registering an advance directive.

Once you create your advance directive, you register it with the Vermont Advance Directive Registry electronic database. You are not required by law to send an advance directive to the registry. However, registered directives give hospitals and other health care providers quick access to them in an emergency. Registration is free for Vermonters.

Create and Register your Advance Directive

Follow these instructions to create and register an advance directive, or to register one you may already have.

1. Print, Complete, and Sign the Forms

  • Choose one of the forms below for your advance directive.
  • Registration Agreement - This is your permission for us to send a copy of your advance directive and emergency contact information to those authorized to access them.

You may use an advance directive from another organization, but you must still include the Registration Agreement.

If you have an existing advance directive:

  • To register an existing advance directive or living will: Fill out the Registration Agreement and send both documents to the address below.

2. Mail or Fax the Advance Directive and Signed Agreement

IMPORTANT: You must send in a signed Registration Agreement.

Mailing address:

Vermont Advance Directive Registry
P.O. Box 2789
Westfield, NJ 07091-2789

Fax: 908-654-1919

Forms

Registration Agreement
The Registration Agreement authorizes the registry to send a copy of your advance directive and emergency contact information to those authorized to have access.

Advance Directive Forms

You may use one of the forms listed below, or another from an organization of your choice. Vermont law does not favor one over another.

Long form (9 sections) – Vermont Department of Health

  • 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

Short Form (5 sections) – Vermont Ethics Network

  • Your Health Care Agent
  • Health Care Goals and Spiritual Wishes
  • Limitations of Treatment
  • Organ/Tissue Donation and Burial/Disposition of Remains
  • Signed Declaration of Wishes

Appointment of a Health Care Agent – Vermont Ethics Network
For those people interested in taking a First Step in advance care planning, this form allows you to appoint a health care agent and provide some general guidance about your health care goals.

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.

Confirmation from the Registry

The Registry will mail you a confirmation letter that the documents were scanned and safely stored in the registry.

You will receive:

  • A letter of confirmation.
  • A registration ID number on a wallet card.
  • Adhesive labels with registry contact information.
  • Instructions for accessing the registry, viewing the documents, and making changes.

Each year, the Vermont Advance Directive Registry will contact you by mail to confirm your advance directive information.

You are responsible for the accuracy of your advance directive. Ensure it reflects your wishes and instructions at all times, and any other important update information such as changes of address for your agent and alternate agents.

Contact Information and Technical Support

Information and General Assistance

For general information, to request forms, help with completing an advance directive or form, or about medical decision making:

To request updated stickers for your ID, or a replacement wallet card:

Technical Support

Help with your account, including how to access your documents online, finding the status of recent submissions, or troubleshooting errors: