Free Medical Power of Attorney VA Form

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A Virginia medical power of attorney is a written document that lets you name an agent to make health care decisions for you if you cannot make them yourself. Virginia law calls it an advance directive.[1] You can create the form online with FormsPal or download the PDF, then follow the signing rules and the part-by-part steps below.

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Download the Virginia Medical Power of Attorney: PDF or Word (.docx) or OpenDocument (.odt)

Looking for another document? See our Virginia power of attorney templates, or read about the medical power of attorney form in general.

Virginia Laws and Requirements

Virginia sets the signing rules for a medical power of attorney in one section of its code. The section covers the points that matter to you as the declarant, the person who makes the directive. They include who may make a written directive, how it is signed, what it may let your agent do, when an oral directive is allowed, and who tells the attending physician.[1]

A written advance directive shall be signed by the declarant in the presence of two subscribing witnesses and may specify the health care the declarant does or does not authorize.

Va. Code Ann. § 54.1-2983

In plain words, a written directive needs your signature and two witnesses who are there when you sign. If you are an adult capable of making an informed decision, you may make a written advance directive at any time.[1]

Choose your agent with care. Talk through your health care wishes with that person before you name them, because they may have to make decisions for you at a hard moment.

Your advance directive may authorize your agent to take any lawful actions needed to carry out your decisions, including releasing your medical records.[1]

Virginia’s suggested advance directive form, in Va. Code § 54.1-2984, has a line for a successor agent. The successor serves if your primary agent is not reasonably available or is unable or unwilling to act.[2]

Oral Advance Directive

The code also allows an oral directive in one situation. An adult capable of making an informed decision who has been diagnosed by the attending physician as being in a terminal condition may make an oral advance directive.

  • The person is an adult capable of making an informed decision.
  • The attending physician has diagnosed the person as being in a terminal condition.
  • The directive is made in the presence of the attending physician and two witnesses.

An oral advance directive must be made in the presence of the attending physician and two witnesses.[1]

Telling Your Attending Physician

It is the responsibility of the declarant, which means you, to provide for notification to your attending physician that an advance directive has been made.[1]

Virginia Medical Power of Attorney Form Details

Document Name Virginia Medical Power of Attorney Form
State Form Name Virginia Advance Medical Directive
State Laws Virginia Code, Title 54.1, Chapter 29, Article 8, including § 54.1-2983[1]
Signing Requirements Signature of the declarant and two subscribing witnesses[1]
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 29
Available Formats Adobe PDF

Filling Out the Form

The FormsPal Virginia medical power of attorney template is an advance directive form with six parts to complete. They run in this order: the agent, the alternate agent, your signature, the notary acknowledgment, the officer's seal line and the two witness blocks. Fill it out on screen with the online PDF editor or print it and write by hand.

The screenshots under each step show the FormsPal Virginia medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.

  1. Principal and Agent (Part I, Section 1). On page 1, write your name and address, then the name and address of the person you appoint as your health care agent.
    Virginia medical power of attorney: POWER OF ATTORNEY FOR HEALTH CARE, filled with sample entries
    Step 1: sample entries, not a real document.
  2. Agent Contact Details and Alternate Agent. Still on page 1, enter the agent's phone, email and alternative contact. In the alternate agent paragraph, repeat the agent's name, then give the alternate's name, address, phone, email and alternative contact. The form says the alternate acts if the agent resigns, dies or is unable or unwilling to act.
    Virginia medical power of attorney: Agent's phone, Agent's email and more, filled with sample entries
    Step 2: sample entries, not a real document.
  3. Date, Signature and Printed Name. On page 6, enter the date on the line after "I have hereunto set my hand on", sign above the signature line and print your name above the printed name line.
    Virginia medical power of attorney: Date, Signature and more, filled with sample entries
    Step 3: sample entries, not a real document.
  4. Notary Acknowledgment. Page 7 holds the acknowledgment. The county, date, officer's name and title, and your name go on the lines of that certificate.
    Virginia medical power of attorney: County, Date and more, filled with sample entries
    Step 4: sample entries, not a real document.
  5. Officer's Signature and Seal. At the bottom of page 7 is the signature and seal line for the notary or other officer who completes the certificate.
    Virginia medical power of attorney: Signature, filled with sample entries
    Step 5: sample entries, not a real document.
  6. Two Witness Blocks. On page 9, each of the two witnesses writes a signature, printed name, address and date in their own block.
    Virginia medical power of attorney: Poa execution va blocks.1.witness 1 signature, Poa execution va blocks.2.printed name and more, filled with sample entries
    Step 6: sample entries, not a real document.

How to Sign and Use the Virginia Medical Power of Attorney

Once the form is filled out, check every entry, sign your advance directive with your witnesses present and tell your attending physician. Then store the original where your agent can find it when healthcare decisions come up. These steps are the process around the form, so they do not follow its pages.

  1. Get the template. Download the advance directive PDF from this page or create the document online with FormsPal before you start filling it out.
  2. Check your entries. Read every entry once more before you sign. Make sure your choices do not contradict each other.
  3. Sign with two witnesses present. Sign the form in the presence of two witnesses, then have each witness complete their block on page 9.[1]
  4. Tell your attending physician. Notify your attending physician that you have made an advance directive, and consider handing the doctor a copy.[1]
  5. Store the original. Keep the signed advance directive in a safe place and give copies to your agent and your alternate agent so they know where to find it.

Download a Free Virginia Medical Power of Attorney Form

You can download the Virginia medical power of attorney as a PDF or create the healthcare document online with FormsPal and print it. The advance directive template has the parts described in the steps above: the agent and alternate agent, your signature, the notary acknowledgment and two witness blocks.

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Create a free high quality Virginia Medical Power of Attorney online now!

Frequently Asked Questions

These short answers cover the witness, oral directive and physician notice rules for a Virginia medical power of attorney. Each answer comes from the Virginia advance directive law listed in the Sources section.

Does a medical power of attorney need witnesses in Virginia?

Yes, a written advance directive does. It must be signed by the declarant in the presence of two subscribing witnesses.[1]

Can a Virginia advance directive be made orally?

In one case, yes. An adult capable of making an informed decision who has been diagnosed by the attending physician as being in a terminal condition may make an oral advance directive. It must be made in the presence of the attending physician and two witnesses.[1]

Do I have to tell my doctor about my advance directive?

In Virginia, it is the responsibility of the declarant to provide for notification to the attending physician that an advance directive has been made.[1]

General information, not legal or tax advice.

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Sources

  1. Va. Code Ann. § 54.1-2983.
  2. Va. Code Ann. § 54.1-2984. Accessed October 15, 2026.
Published: Aug 7, 2022
Mara Erlach
Mara Erlach
Writer & Attorney
Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.

Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current Virginia law. If you notice an error or outdated information, please contact us.