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Virginia Advance Directive to Appoint a Health Care Agent

Appoints a health care agent for periods when the principal is determined unable to make informed decisions; optional powers require careful individual review.

Jurisdiction
Virginia
Purpose
Medical & health care
Source / form version
Updated April 2018, as printed in the form.
Resource format
PDF
Signing
Sign with two adult witnesses. Notarization is not required. The optional care-over-objection section has an additional licensed-professional attestation that is separate from ordinary execution.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Appoint an agent and backup

The Virginia State Bar form focuses on naming someone to make health care decisions. Enter the agent’s contact details and consider a successor. Read the medical and mental-health powers listed in the appointment, and use the space for limitations or additional instructions to communicate what matters to you.

Sources: [1] [3] [4]

Treat the optional objection provision separately

Part C addresses authority that may operate over a later objection under specified circumstances. It is optional and includes an additional statement by a qualified licensed professional. Do not sign that section merely to complete every blank. Discuss its consequences and requirements with an appropriate professional if it is part of your intended plan.

Sources: [1] [3] [4]

Complete witnesses and distribute copies

Ordinary execution calls for your signature and two adult witnesses, without a notary. Keep any properly completed attachments with the form. Give the agent and treating clinicians current signed copies so that the appointment is available when needed. The optional sections should be distinguishable from the basic appointment, and the person you name should understand any limits you have chosen.

Sources: [1] [3] [4]

Common questions

Does appointing an agent immediately take away my medical choices?

No. The agent’s decision-making role depends on the legal determination that you cannot make an informed decision. Continue discussing your wishes directly with clinicians while you are able.

Sources: [1] [3] [4]

Do I have to complete Part C?

No. The provision concerning care over objection is optional. It has its own professional-attestation requirements and should not be treated as a routine witness or notarization step.

Sources: [1] [3] [4]

Related forms and guides

Sources and verification

  1. Virginia State Bar: source and instructions (opens in a new tab)
  2. Direct PDF (opens in a new tab)
  3. Virginia Code §54.1-2983 — advance directives (opens in a new tab)
  4. Virginia Code §54.1-2986.2 — decisions over protest (opens in a new tab)

HTTP 200; three pages and 42 fields. April 2018 edition and optional Part C professional attestation inspected. No notarization claim or blanket statement allowing care over objection. State Bar remains the external publisher.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.