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4. Fill out your form

A hand holding a pen and writing on a form document.

If both doctors decide that you are eligible for voluntary assisted dying, you need to fill out a form.

A person in a hospital bed being cared for by a doctor. The person in the bed has a speech bubble with an icon of a cross over themselves in it.

This form tells your doctor that you want to use voluntary assisted dying.

A doctor holding a form document.

You will get this form from your doctor.

A person making a phone call.

If you lose your form, you can call the ºÚÁϳԹÏÍø Voluntary Assisted Dying Care Navigator Service for a new form.

1300 802 133

2 witnesses pointing to themselves.

You need to sign your form in front of 2 witnesses.

A witness supporting someone. They have a thought bubble with the person they are supporting in it.

A witness is someone who knows you, such as a:

  • friend
  • neighbour
  • support worker.

A witness ³¦²¹²Ô’t be:

A teenager pointing to themself. Above them is the number '17' with an arrow pointing down and a cross.

  • someone who is 17 years old or younger

A family of 4 people.
  • your family member.

A person with a thought bubble that has a house in it and a plus icon above it.

A witness also ³¦²¹²Ô’t be someone that might gain things you own that have value when you die.

A house with a dollar symbol above it.

For example, your:

  • house
  • money.

A doctor with a cross next to them.

Your witness also ³¦²¹²Ô’t be your doctor or someone close to your doctor.

A person with a speech bubble that has a hand holding a pen in it.

If you ³¦²¹²Ô’t sign your form, you can ask another adult to sign for you.

But they ³¦²¹²Ô’t be:

A witness supporting someone. They have a thought bubble with the person they are supporting in it. Above them is a cross.

  • one of your witnesses

A doctor with a speech bubble that has a cross in it.

  • your doctor.

2 people supporting someone to sign a document.

You need to be with the person when they sign your form for you.

You need both your witnesses with you too.

A computer with a hand holding a pen on the screen.

If you ³¦²¹²Ô’t sign your form physically, you may be able to sign it online.

A person handing a signed form document to a doctor.

After you fill out your form, you need to give it to your doctor.