Get Values History Form

The Values History Form is designed to help individuals articulate their personal health care values and preferences. By filling out this form online, users can ensure that their wishes are documented clearly for their loved ones and health care providers.

Follow the steps to complete the Values History Form online

1. Press the ‘Get Form’ button to obtain the Values History Form and open it in the online editor.
2. Begin by entering your name and the date on the form. This will help identify your submission.
3. If someone assisted you in completing this form, provide their name, address, and relationship to you in the specified fields.
4. In the first section, reflect on your overall attitude toward life and health. Answer the questions about your goals, fears, and what makes life worth living.
5. Proceed to the section regarding personal relationships. Describe the role of family and friends in your life and any arrangements for them to make medical decisions on your behalf.
6. Consider the thoughts you have about independence and self-sufficiency. Address how you feel about dependence and your attitude toward potential future health declines.
7. Next, reflect on your living environment over the past decade and how comfort in your surroundings may change due to illness or age.
8. Discuss your religious background and beliefs. Explain how these beliefs influence your feelings toward illness and death.
9. Describe your relationships with doctors and health care caregivers. Comment on your level of trust and communication with them.
10. Share your thoughts about illness, dying, and death. Specify what will be important to you during the dying process, including your preferences for end-of-life care.
11. Discuss your finances, particularly regarding the costs associated with health care and your feelings about financial preparedness.
12. If you have plans regarding your funeral, detail those in the appropriate section.
13. Complete any optional questions if desired, including how you would like your obituary to read or a brief eulogy.
14. Finally, indicate any legal documents related to health care decisions that you have signed and provide their locations as requested.
15. After completing all sections, ensure you save your changes. You can then download, print, or share the form as needed.

Start filling out your Values History Form online today.