Taking Care of What I Value

If you have a medical emergency or mental health crisis, you might not be able to make your own medical decisions or take care of things that matter to you. Are there certain people you’d like to care for your children, pets, or home? You can use this worksheet to discuss your choices with your spokesperson, loved ones, and health care providers. Enter contact information into the sections below that apply to you. Leave blank any sections that don’t apply to you.

After completing the optional worksheet, initial each page and keep a copy of it with your other important papers. (Since this worksheet is not about medical decisions, there is no reason to attach it to your VA Advance Directive.) You should also get legal help to make sure that the people you name on this worksheet will have the legal authority to take care of your loved ones and property.

I want the following person (people) to take care of my CHILD(REN): (Part 1 of 4)
I want the following person to take care of my PET(S): (Part 2 of 4)
I want the following person to take care of my HOME(S): (Part 3 of 4)
I want the following person to take care of my OTHER: (Part 4 of 4)
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...

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.

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

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