Advance Directive Questionnaire — shared by the community
Marta K. shared this 16-question build with 2 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use healthcare & clinical form for small teams who need a reliable intake process: 16 questions, 3 pages, 2 conditional rules.
- Shared by
- Marta K. · Practice manager
- Questions
- 16
- Replies
- 13
- Copies taken
- 706
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Live preview and test console
This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.
Page 1 of 3 — About you and your decision-maker
Every question on this page is currently visible.
Works for you? Take Marta K.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Advance Directive Questionnaire is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in healthcare & clinical.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 16 questions across 3 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 11 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It captures a phone number for urgent follow-up.
- It accepts a document or photo upload as evidence.
- It pins the request to a specific date.
- It allows multiple selections without free text.
- Conditional logic hides 2 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 3 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Advance Directive Questionnaire lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Check the upload limits on the file question so respondents can attach what you actually need.
- 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 2 conditional rules ship with it.
- Features advanced show logic: if “Do you have wishes about artificial nutrition or hydration?” is Yes, described below, the form dynamically exposes “Describe those wishes”. Otherwise that question never appears.
- Features advanced show logic: if “Do you already have a signed, legal advance directive or living will?” is Yes, the form dynamically exposes “Upload your existing document, if any”. Otherwise that question never appears.
- All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — About you and your decision-maker
- Full namerequired
- Date of birthrequired
- State or jurisdiction you live inrequired
- Name of your healthcare decision-makerrequired
- Relationship to yourequired
- Their phone numberrequired
- Alternate decision-maker's name and contact, if any
Page 2 — Your wishes for care
- If you were unable to make decisions, would you want life-sustaining treatment attempted?required
- Describe your wishes in more detail
- Do you have wishes about artificial nutrition or hydration?required
- Describe those wishes
Page 3 — Existing documents and sharing
- Do you already have a signed, legal advance directive or living will?required
- Upload your existing document, if any
- Has this been discussed with your doctor?required
- Who should receive a copy of these wishes?required
- Anything else your care team should know
Conditional logic in this build
- When “Do you have wishes about artificial nutrition or hydration?” is Yes, described below, show “Describe those wishes”.
- When “Do you already have a signed, legal advance directive or living will?” is Yes, show “Upload your existing document, if any”.
Questions about this shared form
Is this form legally binding?
That depends entirely on your jurisdiction's requirements, which vary; this questionnaire records wishes for the person's own file and care team, not as a substitute for a jurisdiction's legal form.
Does the care team have to follow what is recorded here?
It is meant to inform decisions and give the decision-maker and clinicians a clear written statement of wishes; how it is used alongside legal documents depends on local law and your organization's policy.
Should a lawyer be involved?
For the legally binding document, most jurisdictions have their own required form or process; a lawyer or your care team can advise on what applies where the person lives.
Can these answers be updated later?
Yes, and they should be whenever the person's health, wishes or decision-maker changes; complete a fresh questionnaire rather than editing the old one.
Is the Advance Directive Questionnaire template free to use?
Yes. You can preview and test Advance Directive Questionnaire on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Advance Directive Questionnaire template ask for?
It asks 16 questions across 3 pages, 11 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Advance Directive Questionnaire form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this healthcare & clinical form work?
2 conditional rules ship with the template: Features advanced show logic: if “Do you have wishes about artificial nutrition or hydration?” is Yes, described below, the form dynamically exposes “Describe those wishes”. Otherwise that question never appears. Features advanced show logic: if “Do you already have a signed, legal advance directive or living will?” is Yes, the form dynamically exposes “Upload your existing document, if any”. Otherwise that question never appears. All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.
Where do responses to the Advance Directive Questionnaire form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Advance Directive Questionnaire form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Can respondents upload files?
Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.
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