Advance Wishes and Preferences Record

Who this is for

A record of your wishes, in your own words, for the people involved in your care. It sets down what matters most to you, where you would like to be cared for, who you want to speak for you and the things you would not want — so that the people around you are not guessing. It is a record to share, not a legal document.

Anyone who wants the people around them to know what they would choose, people arranging care for themselves ahead of time, and families who would rather have a conversation now than an argument later. It can be written with help, and it belongs to the person it is about.

What this helps you track

• What matters most to you, written before anyone has to ask
• Where you would like to be cared for, and where you would rather not be
• Who you want to speak for you and who you want involved
• The things you would not want, and the things you would
• Where any formal documents you have made are kept

How to use it

1. Write your name and the date at the top, and the name of anyone who helped you fill it in.
2. Answer each prompt in your own words — a few lines is enough, and blank is fine where you have no view.
3. List the people you want involved, with how to reach them, and say plainly who speaks for you if you cannot.
4. If you have made formal documents where you live, note what they are and where they are kept; ask about them if you have not and want to.
5. Give a copy to the people named on it and keep one with your papers.
6. Read it again when something changes and write a new one with a new date; the newest one is the one people will use.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Is this a legal document?

No. It is a record of your wishes, written to be shared with the people involved in your care. Whether and how wishes can be made formal or binding is decided by the rules where you live, so ask about the formal documents there if that is what you want. This sheet does not stand in for them.

Who should I give it to?

The people named on it, anyone who helps care for you, and whoever holds your papers. A wish that nobody has read cannot be followed.

Do I have to fill in every box?

No. Leave blank anything you have not decided or would rather not say. What is written is yours; what is not written is simply not written.

Can somebody else write it for me?

Yes, in your words and with your agreement, and their name goes on the sheet as the person who helped. It stays your record.

What if I change my mind?

Write a new sheet, date it and tell the people who have the old one. The date is there so that the most recent version is obvious.