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Access Washington Logo linking to Access Washington Home Page

Step 2: Complete Registration Form

Step 2: Complete Registration Form

  • Read the Registration Agreement / Authorization to Change form (520 KB PDF) carefully.
  • By completing a Registration Agreement / Authorization to Change form, you are giving the Washington State Living Will Registry permission to send an exact copy of your health care directive document(s) and emergency contact information to your attending health care provider.
  • To register, you must be at least 18 years of age and have the capacity to make health care decisions.
  • Be sure to sign and date the Registration Agreement / Authorization to Change form.
  • Make copies of your Registration Agreement / Authorization to Change form to mail to the registry.

Step 3: Mail Documents

DOH Logo linking to the DOH Home Page

Washington State Department of Health
Living Will Registry
101 Israel Rd SE
PO Box 47813
Olympia, WA 98504-7813

Send inquires about DOH and its programs to the Health Consumer Assistance Office
Comments or questions regarding this web site? Send mail to the Web Coordinator

Last Update : 11/02/2009 07:04 AM