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Advance Care Planning Engagement Survey
A validated, easy-to-use survey that measures behavior change in response to advance care planning interventions. The survey is available in a patient-facing and surrogate-facing version. Each version is available in multiple languages.
Please complete the form to access the Survey.
It is costly to keep our forms legal for US states and in many languages. Your help will allow us to continue to provide our programs and reach the people who need them most.
Every dollar helps maintain our online programs, easy-to-read legal advance directives, and provider and community tools. It also ensures our materials remain free for individual use.
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PREPARE materials can be used freely by individuals for personal use who agree to the Terms of Use. It is OK to print materials directly from the PREPARE website for individual use. Please ONLY download and use materials directly from the PREPARE website as we update materials often based on state law and other changes. It is OK to provide the "PREPAREforYourCare.org” URL in written or web-based materials. However, a license is required to use the URL or any materials in mass distribution (e.g., to send the URL via electronic health record, email, or SMS text message).
All other uses of PREPARE materials require a license, including to (i) post or distribute PREPARE PDFs or any other PREPARE materials on other parties’ websites or other platforms; (ii) include PREPARE materials within other parties’ print or electronic materials; (iii) modify (e.g., cobrand, white label, or change any text of) any PREPARE materials; (iv) use PREPARE materials in research, quality improvement initiatives, or for data reporting purposes; or (v) use or reproduce PREPARE materials for commercial purposes.
See the PREPARE Terms of Use. See the PREPARE licensing options. For any questions or requests, visit the Contact page.