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.

PREPARE VT Advance Directive
The PREPARE for Your Care Advance Directive was developed by the University of California and has been adapted for all 50 states. This easy-to-read form complies with Vermont law and includes the appointment of a health care agent and documentation of your health care preferences.

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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 all Vermont residents. The Vermont Advance Directive Registry (VADR) is a secure online database that is part of the national US Advance Care Plan Registry (USACPR, formerly the 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 to register a copy of your advance directive, and your directive is valid as soon as signing and witnessing is properly completed.

To register your advance directive, please choose your preferred submission method:

User Upload

  1. Upload a PDF of your document yourself using User Upload. The VADR’s Create My Account option allows you to create your account online, and upload a PDF copy of your completed advance directive. 
  2. Create your account.


If you register via user upload, the VADR Registration Agreement/Authorization to Change form is not required. If you do use this option, you will give permission to create and update your account online during the upload process.

 

Mail, Fax or Email

If you are not able to use the user upload process above, there are updated options to mail, fax or email your submission for registration.

If you are submitting your document via mail, fax, or email, you must also include a signed and completed VADR Registration Agreement/Authorization to Change form. This form can also be requested via phone by calling 1-802-828-2909.

MAIL:
Vermont Ethics Network
61 Elm Street, Suite 1
Montpelier, VT 05602

FAX: 1-802-828-2646

EMAIL: [email protected]

Phone or email requests for account support or new advance directive paperwork are now being received at 1-802-828-2909 or [email protected].

Documents sent to the Westfield, New Jersey address or to the prior submission email or fax number are still being received and will be processed as usual. If you have sent your document to the New Jersey address, you may experience a slight delay in receiving your confirmation letter via mail.
 

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 VADR, send copies of the new document to anyone with a copy of your previous advance directive. 

    If you have access to a computer, you can upload a PDF copy your new directive by logging in to your account and selecting ‘Upload or Replace My Documents’.

     

    Go to Log In page
     

    If you need help logging in to your account, please follow the password reset instructions on the log in page. If you need further assistance, please email [email protected] or call 1-802-828-2909 .

OR

2. Email, mail or fax a copy of the newly signed advance directive form AND an Authorization to Change form* to:

  • Email: [email protected]
  • Mail: 
    Vermont Ethics Network
    61 Elm Street, Suite 1
    Montpelier, VT 05602
  • Fax: 1-802-828-2646
     

*Mail, fax, and email submissions that do not include both forms will be returned by mail for correction. 

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 Ethics Network
    61 Elm Street, Suite 1
    Montpelier, VT 05602
  • Fax: 1-802-828-2646
  • Email:[email protected] 
     

If your submission is missing required paperwork, or is not completed properly, your submission will be returned to you via mail or email with your documents and the needed information for resubmission included. If you have questions about your submission, or about advance directives in general, please see the support options below:

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

The Vermont Advance Directive Registry no longer mails annual reminder letters. Annual reminders are only sent via email. If you would like to receive annual reminders, please log in to your account and provide your email address. If you would like to receive a physical copy of your account information and advance directive on file, please call 1-802-828-2909 or email [email protected] to request an account overview.

For assistance with Vermont Advance Directive Registry accounts, questions about advance directives, 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 Thursday, 9:00 am – 5:00 PM)

U.S. Living Will Registry

For help with an error message in your existing account, or if you are a provider who needs access to a patient’s directive:
[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. If you need to order a new card, you can do so by logging in to your account and selecting ‘Order New Wallet ID”. If you cannot log in to your account, please call 1-802-828-2909 or email [email protected] for assistance.