ACP forms for your state or territory

Find the right forms

Forms and requirements for writing advance care plans and appointing substitute decision-makers vary between and states and territories.

Please note: ACPA is not responsible for the maintenance or currency of forms and information on these sites. If you have trouble finding material when you access a link from the ACPA website, please contact the relevant website owner directly (E.g. state government department).

In the Australian Capital Territory, the components of an advance care plan are:

  • Advance Care Plan Statement of Choices: Competent Person form or No Legal Capacity form
  • Enduring Power of Attorney
  • Health Direction (optional)

  • Form

    Advance Care Plan Statement of Choices - Competent Person (ACT)

    ACT Government

    Form for a person able to make decisions to record choices regarding future medical treatments and procedures, to inform a substitute decision-maker and doctor.

  • Form

    Advance Care Plan Statement of Choices - No Legal Capacity (ACT)

    ACT Government

    If a person is no longer able to make or communicate their decisions, a substitute decision-maker can record choices regarding medical treatments and procedures on a person's behalf using this No Legal Capacity form.

  • Form

    Enduring Power of Attorney (ACT)

    ACT Government

    View the form to legally appoint a substitute decision-maker in the Australian Capital Territory.

  • Form

    Health Direction form (ACT)

    ACT Government

    With the Health Direction form, a person can legally record their future healthcare decisions, including refuse medical treatment generally, or withhold or withdraw treatment of a particular kind. This form is optional.

Related information for ACT

  • Website

    Advance Care Planning Program (ACT)

    ACT Government

    The Advance Care Planning (ACP) Program in the Australian Capital Territory provides a quality assured system of discussing, recording and documenting a person's healthcare wishes.

  • Website

    Chronic Care Program – Advance Care Planning service (ACT)

    ACT Government

    The Chronic Care Program (CCP) has established two Advance Care Planning clinics to assist patients in the Chronic Care Program complete advance care plans.

In New South Wales, the form components of an advance care plan are:

  • Advance Care Directive / Statement of Values and Wishes: NSW does not have a specific form for an advance care directive and some local health districts have forms a person may complete in those districts (such as Statement of Values and Wishes). Anyone can use these forms as a template for writing their own advance care directive. You can also write down your wishes in a letter. Make sure to write down specific information relating to your wishes, values, and any treatments you would not wish to receive to inform your doctor and substitute decision-maker, signed by yourself and a witness. Your form or statement is supported under the Guardianship Act 1987 and has been confirmed by the NSW Supreme Court in 2009 that an Advance Care Directive is legally binding.
  • Enduring Guardian: An individual can appoint or revoke an Enduring Guardian, or resign as an Enduring Guardian.
  • Form

    Making an Advance Care Directive (NSW)

    NSW Government

    This package includes an Advance Care Directive form and Information Booklet, and is one of many advance care planning and end of life resources available for use for those living in NSW.

  • Form

    Statement of Values and Wishes (South Western Sydney, NSW)

    NSW Government

    View the advance care plan form available to those living in South Western Sydney, NSW. It can be used as a template for anyone writing an advance care plan.

  • Form

    Appointment of Enduring Guardian (NSW)

    NSW Government

    As part of your advance care plan, you can legally appoint a substitute decision-maker under the Guardianship Act 1987. The Appointment of Enduring Guardian form is required to choose a substitute decision-maker in New South Wales.

  • Form

    Notice of Resignation as Enduring Guardian (NSW)

    NSW Government

    A substitute decision-maker can resign by giving written notice using this form to the person who appointed them. This form can only be used if the appointor still has the capacity to make personal decisions. Otherwise, the substitute decision-maker can only resign with approval from the NSW Civil & Administrative Tribunal.

  • Form

    Revocation of Appointment of Enduring Guardian (NSW)

    NSW Government

    View this form to revoke your appointment of an Enduring Guardian in New South Wales.

Related information for NSW

  • Website

    Advance care planning in New South Wales

    NSW Government

    Learn more about advance care planning in New South Wales through the NSW Health website.

  • Website

    SLHD My Wishes (NSW)

    Sydney Local Health District

    Fact sheets and translations, booklets, templates and other advance care planning resources from Sydney Local Health District.

 In the Northern Territory, there is one form component to an advance care plan:

  • Advance Personal Plan
  • Register an Advance Personal Plan (optional). You may also register your Advance Personal Plan with the Public Trustee using the Application to Register an Advance Personal Plan form. If you use this form to appoint a substitute decision-maker as well, you must then register that section of the form with the Land Titles Office.

  • Form

    Advance Personal Plan (NT)

    Northern Territory Government

    In the Northern Territory, a person 18 years or over must complete the Advance Personal Plan form to make a legally-binding advance care plan. It can include decisions about future healthcare, statements about their views, wishes and beliefs, and appoint one or more persons as a substitute decision-maker.

  • Form

    Application to Register an Advance Personal Plan (NT)

    Northern Territory Government

    View the form to register an advance care plan with the Public Trustee of the Northern Territory.

  • Form

    Application to Search or Obtain Information from the Advance Personal Plan Register (NT)

    Northern Territory Government

    Use this form as a spouse, de facto partner, child, or medical practitioner of a person who has made an Advance Personal Plan in the Northern Territory to apply to be provided with information concerning their advanced care plan.

Related information for NT

  • Website

    Advance care planning in the Northern Territory

    Northern Territory Government

    Learn more about advance care planning in the Northern Territory through the Northern Territory Government website.

In Queensland, the form components of an advance care plan are:

  • Advance Health Directive: You can print or fill out a PDF form online, or purchase a form from a newsagent or other private business in Queensland (such as a bookshop or stationer)
  • Enduring Power of Attorney: Short form (one decision-maker) or Long form (multiple decision-makers)
  • Statement of Choices
  • Form

    Advance Health Directive form (QLD)

    Queensland Government

    Download the form for people living in Queensland, that states your wishes or directions regarding your future health care for various medical conditions. It comes into effect only if you are unable to make your own decisions.

  • Form

    Enduring Power of Attorney – Short Form (QLD)

    Queensland Government

    This Short Form is to legally appoint one attorney/substitute decision-maker for personal matters (including healthcare) and/or financial matters, including allowing them consent to withdrawing or withholding life-sustaining treatment.

  • Form

    Enduring Power of Attorney – Long Form (QLD)

    Queensland Government

    This Long Form is to legally appoint more than one attorney/substitute decision-maker, such as an attorney(s) for personal matters, including healthcare, and a different attorney(s) for financial matters, including allowing them consent to withdrawing or withholding life-sustaining treatment.

  • Form

    Revocation of Enduring Power of Attorney (QLD)

    Queensland Governement

    Visit the Queensland Government site to access the form required if you wish to revoke (cancel) the appointment of a person or persons as your attorney/s (enduring power).

  • Form

    Statement of Choices (QLD)

    Queensland Government

    The Statement of Choices allows a person to record their personal values and preferences for health care, helping family and healthcare professionals decide on medical care when a person is unable to make or communicate decisions. There is a form for those who have decision-making capacity (Form A), and those without decision-making capacity (Form B).

Related information for QLD

  • Website

    Advance care planning in Queensland

    Queensland Government

    Learn more about advance care planning in Queensland through the Queensland Government website.

South Australia has one component to make an advance care plan:

  • Advance Care Directive

Note: The new Advance Care Directive replaces the Enduring Power of Guardianship, Medical Power of Attorney and Anticipatory Direction documents. If a person has completed one of these documents before 1 July 2014, they will continue to have legal effect.

  • Form

    Advance Care Directive (SA)

    Government of South Australia

    Download the Advance Care Directive form for South Australia. A person 18 years or over must complete this form to make a legally-binding advance care plan. A person uses this form to appoint a substitute decision-maker as well.

  • Form

    Advance Care Directive - Online form and DIY Kit (SA)

    Government of South Australia

    Complete your Advance Care Directive form online or download a do-it-yourself kit, which provide a step-by-step guide for making an advance care plan in South Australia, information for witnesses, substitute decision-makers and interpreters, and tear out forms.

  • Form

    Advance Care Direct wallet card (SA)

    Government of South Australia

    View the wallet-sized form with the details of a substitute decision-maker.

Related information for SA

  • Website

    Advance care planning in South Australia

    Government of South Australia

    Learn more about advance care planning in South Australia through the SA Health website.

  • Website

    Advance Care Directives - South Australia

    Government of South Australia

    Learn more about advance care planning in South Australia through the Advance Care Directives website.

In Tasmania, the components of an advance care plan are:

  • Advance Care Directive: (Also available in large print)
  • Enduring Guardian: Including forms to apply for recognition if in another state or territory, or in emergency situations.

  • Form

    Advance Care Directive for Care at the End of Life (TAS)

    Tasmanian Government

    Use the Advance Care Directive form if you live in Tasmania, to write down specific information relating to your wishes, values and any treatments you would not wish to receive, to inform your doctor and substitute decision-maker.

  • Form

    Large Print Advance Care Directive for Care at the End of Life (TAS)

    Tasmanian Government

    Use the Advance Care Directive form if you live in Tasmania, to write down specific information relating to your wishes, values and any treatments you would not wish to receive, to inform your doctor and substitute decision-maker. Now available in large print.

  • Form

    Instrument Appointing Enduring Guardian(s) (TAS)

    Tasmanian Government

    In Tasmania, a substitute decision-maker is referred to as an enduring guardian. A person can appoint enduring guardians under the Guardianship and Administration Act 1995 as substitute decision makers.

  • Form

    Application for Recognition of Interstate Appointment (TAS)

    Tasmanian Government

    View the form required to register and appoint a substitute decision-maker or administrator in Tasmania, made in another Australian state or territory.

  • Form

    Request for Emergency Order (TAS)

    Tasmanian Government

    View the form to legally appoint a substitute decision-maker in urgent situations, when the person has not already made an enduring power of attorney or appointed an enduring guardian.

Related information for TAS

  • Website

    Advance care planning in Tasmania

    Tasmanian Government

    Learn more about advance care planning in Tasmania through the Department of Health and Human Services website.

In Victoria, the components of an advance care plan are:

  • Advance Care Plan *
  • Enduring Power of Attorney (Medical Treatment) *
  • Refusal of Treatment Certificate: Competent person form or Guardian of Incompetent person form *

*Please note: The Medical Treatment Planning and Decisions Act 2016 goes into effect 12 March 2018, affecting these forms.

  • If you have completed the forms prior to 12 March 2018, they will still be valid. You will not be required to complete new forms.
  • If you are completing forms after 12 March 2018, different forms will be required. These will be available closer to the date.

  • Form

    Advance Care Plan - Form/Template (VIC)

    Victorian Government

    The state of Victoria offers a template that a person may fill out or use as an example to write their own advance care directive. Write down specific information relating to your wishes, values and any treatments you would not wish to receive.

  • Form

    Appoint an Enduring Power of Attorney (Medical Treatment)

    Office of the Public Advocate

    In Victoria, a substitute decision-maker is known as a 'medical agent' and is appointed using a Medical Enduring Power of Attorney form. Find the form and more information about this legal document, where an individual appoints another person with the power to make decisions about medical treatment on their behalf.

  • Form

    Refusal of Treatment Certificate Competent Person (VIC)

    Office of the Public Advocate

    A patient can write a 'refusal of treatment' certificate, but only for a current illness, which does not have to be terminal (Medical Treatment Act 1988). The form for this is the Refusal of Treatment Certificate Competent Person (VIC), the certificate required if a person who is able to make decisions is refusing treatment in Victoria.

  • Form

    Refusal of Treatment Certificate Agent or Guardian of Incompetent Person (VIC)

    Office of the Public Advocate

    The legislation allows the appointment of an agent/substitute decision maker who can refuse treatment. The form for this is the Refusal of Treatment Certificate Agent or Guardian of Incompetent Person (VIC). That is, when a substitute decision-maker refuses treatment on behalf of a person who is unable to make decisions.

Related information for VIC

Please be advised that the Medical Treatment Planning and Decisions Act 2016 goes into effect 12 March 2018. Following is information for individuals and healthcare professionals about the Act, including answers to common questions

  • Website

    Advance care planning in Victoria

    State Government of Victoria

    Learn more about advance care planning in Victoria through the Department of Health and Human Services website.

  • Articles & Publications

    Medical Treatment Planning and Decisions Act 2016 FAQ (VIC)

    State Government of Victoria

    Answers to common questions for health practitioners and individuals who are affected by or interested in the Act that comes into effect March 2018.

  • Articles & Publications

    Summary of the Medical Treatment Planning and Decisions Act 2016 (VIC)

    State Government of Victoria

    A summary of the Medical Treatment Planning and Decisions Act 2016 for health practitioners.

  • Articles & Publications

    Guide to the Medical Treatment Planning and Decisions Act 2016 (VIC)

    State Government of Victoria

    A guide to understanding the Medical Treatment Planning and Decisions Act 2016 for health practitioners.

In Western Australia, the components of an advance care plan are:

  • Advance Health Directive
  • Enduring Power of Guardianship
  • Advance Care Plan
  • Form

    Advance Health Directive (WA)

    Government of Western Australia

    Legally record your decisions for future health care treatments and procedures in an Advance Health Directive. The Guardianship and Administration Act 1990 was amended by the Acts Amendment (Consent to Medical Treatment) Act 2008, to include an Advance Health Directive to refuse treatment for a current condition or terminal illness.

  • Form

    Advance Health Directive Alert Card (WA)

    Government of WA, Department of Health

    Legally record your decisions for future health care treatments and procedures in an Advance Health Directive. Download an alert card recording all of your key information and Advance Health Directive contacts in small wallet sized card.

  • Form

    Enduring Power of Guardianship - Information Kit and Form (WA)

    Government of Western Australia

    In Western Australia, a substitute decision-maker is referred to as an enduring guardian. View the information and form to legally appoint a substitute decision-maker in Western Australia. The form is included towards the end of the information kit.

  • Form

    My Advance Care Plan (WA)

    Government of Western Australia

    A person living in Western Australia can record additional personal wishes not covered in the Advance Care Directive or Enduring Power of Guardianship in a separate form called an Advance Care Plan. This form records additional personal wishes not covered in other formal WA documents.

Related information for WA

  • Website

    Advance care planning in Western Australia

    Government of WA, Department of Health

    Learn more about advance care planning in Western Australia through the WA Department of Health website.