Get the free Advance Statement of Preferences Form

Use this form to make an Advance Statement of Preferences, which explains your wishes regarding treatment under compulsory assessment or treatment as per the Mental Health and Wellbeing Act 2022.

How to fill out advance statement of preferences

How to fill out advance statement of preferences

1. Begin by gathering all necessary personal information including your name, date of birth, and contact details.
2. Consider the medical treatments and interventions you wish to include in your statement.
3. Reflect on your values and beliefs regarding health care decisions.
4. Clearly outline your preferences for treatment options, specifying any procedures you do or do not want.
5. Identify a trusted individual or surrogate decision-maker to communicate your preferences if you're unable to do so.
6. Review and revise your statement to ensure it accurately reflects your wishes.
7. Sign and date the document, and ensure it is witnessed if required by local laws.
8. Share copies of the statement with your healthcare providers and your designated decision-maker.

Who needs advance statement of preferences?

1. Individuals who want to have their medical treatment preferences respected.
2. People with chronic illnesses or conditions that may affect their ability to make decisions.
3. Those undergoing major surgery or facing critical health situations.
4. Anyone looking to relieve family members from the burden of making difficult medical choices.

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What is advance statement of preferences?

An advance statement of preferences is a legal document that allows individuals to outline their healthcare preferences and decisions about their medical treatment in advance, particularly in case they become unable to communicate their wishes.

Who is required to file advance statement of preferences?

While no one is legally required to file an advance statement of preferences, it is strongly recommended for individuals, especially those with serious health conditions or those approaching end-of-life, to ensure their wishes are known.

How to fill out advance statement of preferences?

To fill out an advance statement of preferences, individuals should consider their healthcare desires, discuss them with their family and healthcare providers, and complete the document by clearly writing down their preferences regarding medical treatments and appointing a healthcare proxy if desired.

What is the purpose of advance statement of preferences?

The purpose of an advance statement of preferences is to guide healthcare providers and loved ones in making medical decisions that align with the individual's values and wishes when they are unable to express them.

What information must be reported on advance statement of preferences?

The advance statement of preferences typically requires information such as the individual's healthcare wishes, types of treatments they would or would not want, and the appointment of a healthcare proxy or agent if desired.