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Digital Healthcare Values Directive

Complete the digital healthcare values directive form below

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Would you like to name a Medical Decision Maker for when you are not able to speak for yourself? This may be a person who knows your values and can advocate for you.
Rank the values below based on how important they are to you
Communication
Physically active
Independence
Truthfulness
Privacy
Frank and Directness
Career
Hobbies and past times
Your sense of self is very important. Chose all that describe what are the most important abilities for you to maintain
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If I end up in a permanent vegetative state or with severe neurologic (brain) damage, I want:
If I am given a terminal diagnosis or in the end-stage of my condition, I want:
I enjoy eating foods that bring me pleasure. If I am no longer able to take food by mouth, I want:
Do you agree or disagree with this statement?: "If the only way for me to continue living is in the hospital setting on machines, I choose to stop the machines and have a natural death."
I am willing to have aggressive interventions and procedures done only when there is a good chance I will recover or show significant medical improvement within a reasonable amount of time (up to two weeks). If I do not improve, then I want interventions to stop and allow me to have a natural death. This includes ventilators, dialysis, and ECMO
Upload any documents or photos you would want to share that highlight your wishes or celebrate who you are
Upload File
Check all services you would like to add
If you would like to give any guidance to what you want following your death, please feel free to answer the following questions.

Thanks for submitting your digital healthcare values directive!

Digital healthcare values directive 

Our goal is to ensure you have control over your medical decisions. Click the link below to access the digital values-based directive. Complete it now for only $9.99! 

 

If you would like to complete your directive with a professional Clinical Ethicist during a virtual consultation, click the request a consultation button below and complete  the information. Virtual sessions are $99 for the first 30 minutes and only $49 for each additional 30 minutes.

 

Some states require notarizing and/or witnesses for the directive to be legally binding. Digital notary services are available. 

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Schedule a values based directive virtual consultation (private)

Want to have some face-to-face time with a professional who can help you address your specific needs?

We have Clinical Ethicists available to spend time with you going over your questions and help you fill out your directive in a way that ensures your voice is heard. Giving your clarity and security in your decision making!