Virginia law states that the physician or psychologist must sign “at the time” that you sign the form. You should arrange to sign this form, and have it witnessed, on or near the date that you take your form to get it signed by your physician or licensed clinical psychologist.

Once you get all the signatures needed, you should attach copies of the amendment to all copies of your Advance Directive.  That includes the copies that health care providers, health care facilities, and your agent have.

You can download a PDF here.

An Add-On Option: Mental Health-Specific AD

Some people want to create a separate AD about their mental health care.  Other people may want to add mental health care details to the AD that they already have.  In either case, the Mental Health-Specific AD form is helpful.  

Whether you use the form to make a separate AD or plan to attach it to your existing AD, be sure to share copies with your providers and loved ones.

You can download a PDF here.

An Add-On Option: End-of-Life Instructions if Pregnant

Some women want to provide an alternate set of instructions for end-of-life care in the case that they are pregnant.  In other words, a woman may generally not want life-prolonging treatments for herself if she has a terminal condition.  But, if she were pregnant, she would want providers to treat her if it is possible for the fetus to develop and be delivered.  She can put instructions for both scenarios in her AD to make clear that she wants an alternate plan if she is pregnant.
If you opt to add this form to your AD, be sure to attach it to your AD and/or share copies with your providers and loved ones.

You can download a PDF here.

Because it is going to be a part of your Advance Directive, it must meet the two basic rules for ADs in Virginia:


1. You must sign it, and

2. It must be signed by two adult witnesses, who saw you sign it.

3. It must also meet the extra requirement of having a physician or licensed clinical psychologist sign it.

An Add-On Option: Giving Your Agent the Power to Authorize Treatment Over Your Objection

Some Advance Directive forms do not include the protest provision option. Here we provide an add-on version so that you can add a protest provision to your existing AD if you want.      

​To add the protest provision to your AD, you must complete a few steps:​​

Other Forms and Options