Advance Care Directives-Surveys for people who have done an ACD and substitute decision makers

We appreciate you taking the time to help us improve people's experiences with advance care directives. The first survey is for people who have completed an ACD, tried to complete one or helped someone complete one. The second survey is for people with experience of being a substitute decision maker.
You may complete one or both surveys.

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* 1. How easy or hard was it for you to get an ACD form?

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* 2. Where did you get your ACD DIY Kit or form?

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* 3. How easy or hard was it for you to fill out the ACD form?

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* 4. If you used a DIY ACD Kit did you find it was:

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* 5. When you completed your ACD, did you appoint one or more Substitute Decision Makers?

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* 6. In Part 3 of the ACD form "What is important to me-my values and wishes" there are 6 areas the document suggests for you to consider when decisions are being made for you. Which of these things did you consider and include in your ACD?

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* 7. Part 4 of the ACD form allows you to fill our a section titled "Binding refusals of health care". In this part you can state what health care you do not want and the circumstances in which your refusal will apply. Did you fill out this section?

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* 8. Once you have completed your ACD it must be signed and witnessed. How easy or hard was it for you to find a witness?

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* 9. Did you complete your ACD yourself, or did you have a lawyer or someone else complete it?

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* 10. Thank you for taking the time to provide us with this information. If there is anything further you would like to say about Advance Care Directives please use the textbox below.

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