Name(Required) First Last Email(Required) Do you already have advance directives?(Required)YesNoIf yes, which documents do you have? (Please select all that apply)(Required) Living will Healthcare surrogate DNR (Do Not Resuscitate) Funeral arrangements If yes, when were your directives completed?(Required) Less than 12 months 1 to 2 years 2 to 4 years More than 5 years If more than 5 years, how many years has it been since you last reviewed your directives?(Required) How did you hear about this program?Have you had advance care planning discussions with your family or doctor?(Required)YesNoI would like to receive future communications about My Life, My Care services(Required) Yes No Δ A health crisis can hit anyof us, anytime, at any age.Be in control of your healthcare wishes by completingyour advance care plan.