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8110 Gatehouse Road, Falls Church, VA 22042

Making End-of-Life Healthcare Decisions

Advance Directive Forms

Complete and sign the form specific to your place of residence. Equally important, share this document with your family members and provide signed copies to your physicians for placement in your medical record.

For Virginia Patients

Notes for Virginia Patients

Virginia patients with a mental health treatment history should complete the general Advance Directive form above AND a Mental Health supplement form.

Virginia patients who may be pregnant at the time of their treatment may wish to complete an advance directive form that includes an optional “life prolonging procedures during pregnancy” provision. This form is available on the Virginia Hospital and Healthcare Association website.