Choosing a Spokesperson

This worksheet will help you choose the best spokesperson for you. Your spokesperson should be a competent adult. This worksheet is only to help you choose your spokesperson. After you choose your spokesperson, you will need to talk to that person and let other people know you have chosen that person. You should also complete an advance directive to make your choice official.

Names of possible spokespersons? (Part 1 of 3)

Enter the names of up to 3 people you're considering to be your spokesperson.










Who should speak for you? (Part 2 of 3)

For each person, consider each statement and if the statement is true, mark the box next to that person's name. If the statement is not true leave the box blank.

Spokesperson overview (Part 3 of 3)

You should think about how important each statement is to you when choosing the best spokesperson for you.

Would be willing to speak for me.
Would be able to act on my wishes instead of his/her own wishes.
Lives close by or could travel to be at my side if needed.
Knows me well and understands what's important to me.
Could handle the responsibility.
Will talk with me now about sensitive issues and will listen to my wishes.
Would be available in the future if needed.
Would be able to handle conflicting opinions between loved ones and/ or medical personnel.
Would be firm yet flexible when faced with confusion and chanding information.
Would be able to communicate well and be clear and strong when talking with doctors or hospital officials.
Optional: Add some notes for yourself
Worksheet Complete!

Great job on finishing this worksheet, at this time you can either download the PDF of your worksheet or email it to yourself.

Next Steps...

For guidance about how to talk to your loved ones and health care providers abour your wishes

To include your preferences about the use of life-sustaining treatment in an advance directive.

This worksheet will help you let your doctors and loved ones know your wishes for mental health care if you have a serious mental health condition.