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Advance Directive Form

Asks about life-sustaining treatment preferences, cardiopulmonary resuscitation (CPR) preference, and mechanical ventilation preference. Built for hospital admission advance directive screening.

Questions
14
Page
1
Time
about 4 min

Includes

  • E-signature
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Your practice

Live preview. Tap through it like a patient.

Who it is for

  • Hospital admission advance directive screening
  • Primary care annual wellness visit documentation
  • Geriatric and palliative care patient planning
  • Surgical pre-admission advance care planning

What's inside

  1. Full NameText · Required
  2. Date of BirthDate · Required
  3. Life-Sustaining Treatment PreferencesMultiple Choice · 3 choices · Required
  4. Cardiopulmonary Resuscitation (CPR) PreferenceMultiple Choice · 2 choices · Required
  5. Mechanical Ventilation PreferenceMultiple Choice · 3 choices · Required
  6. Artificial Nutrition and Hydration PreferenceMultiple Choice · 3 choices · Required
  7. Healthcare Proxy NameText · Required
  8. Healthcare Proxy Phone NumberPhone · Required
  9. Healthcare Proxy RelationshipText · Required
  10. Additional Wishes or InstructionsLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Advance Directive Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

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Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Advance Directive Form works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Advance Directive Form to your account and make it yours in a few minutes.

Cancel anytime · BAA included

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