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Advance Care Directive Instructions

Wills, Powers of Attorney & Estate Planning

How this works. Complete the form below and tap Submit. This captures your instructions for an Advance Care Directive under South Australian law — it is not the legal document itself, which must be completed on the prescribed form and witnessed correctly. We will prepare the document from your answers and arrange a time for you to sign it. Fields marked * are required. If you or someone else is in immediate danger, call 000.

Your contact details

Part 1 - About you

Optional, only if you want it recorded

Part 2 - Your substitute decision-maker(s)

Your substitute decision-maker makes health, accommodation and personal decisions for you if you are unable to. Discuss this with them first.
Optional
If you appoint more than one, how should they act?
E.g. matters they must not decide. Leave blank for no limits.

Part 3 - Your values and wishes

E.g. recognising family, being free from severe pain, living at home
E.g. being permanently unable to communicate, being kept alive with no prospect of recovery
If you become seriously ill, where would you prefer to be cared for?
Anything you want respected in your care and after death

Part 4 - Health care instructions

These instructions apply if you have a terminal illness, a progressive incurable condition, permanent unconsciousness, severe brain damage, advanced dementia, or another condition you describe below.
Leave blank to apply them generally
Cardiopulmonary resuscitation (CPR)
Mechanical ventilation / life support
Intensive care admission
Artificial nutrition and hydration (tube feeding / drip)
Kidney dialysis
Antibiotics for a life-threatening infection
Blood or blood product transfusion
Major surgery
Pain relief and comfort care, even if it may shorten life
Expand on any 'only in circumstances' answers above, or add other treatments

Part 5 - Accommodation and personal affairs

E.g. stay at home with care, or move to a named facility
E.g. who may visit, care of pets, who should be told about your condition

Part 6 - Organ and tissue donation

Organ and tissue donation

Revocation

Do you have an earlier advance care directive that needs to be revoked?

Your answers are sent securely over HTTPS to East End Legal’s mailbox. Email is not completely secure, so please do not type passwords, PINs, full account numbers or card numbers into this form.