PERSONAL DIRECTIVE
of ____________________

I, ____________________ (the "Maker"), of ______________________________________________________________, phone: __________, being of sound mind and at least 18 years of age, make this Personal Directive fully understanding the consequences of my action in doing so. I intend this Personal Directive to be read by my health care providers, family and friends as a true reflection of my wishes and instructions should I lack Capacity and be unable to communicate such wishes and instructions.

1. Definitions
   
1. As used in this document:
   
   1. "Act" means the Personal Directive.
      
   2. "Capacity" means the individual is able to understand the information pertaining to the personal decision and also is able to understand the reasonably foreseeable consequences of the decision.
      
2. Designation of Agent
   
2. I do not wish to designate an Agent, but provide the following information and instructions to be followed by a service provider who intends to provide personal services for me.
   
3. Notwithstanding the previous clause, I give no one (including my Agent) any authority to disregard or override my instructions provided in this Personal Directive. Family members, relatives, friends may disagree with me, but any such disagreement does not diminish the strength or substance of my instructions.
   
4. Revocation
   
4. The authority granted in this Personal Directive may be revoked as and where permitted by law.
   
5. I understand that, as long as I have Capacity, I may revoke this Personal Directive at any time.
   
6. General
   
6. A copy of this Personal Directive has the same effect as the original.
   
7. If any part or parts of this Personal Directive is found to be invalid or illegal under applicable law by a court of competent jurisdiction, the invalidity or illegality of that part or parts will not in any way affect the remaining parts and this document will be construed as though the invalid or illegal part or parts had never been included in this Personal Directive. But if the intent of this Personal Directive would be substantially changed by such construction, then it shall not be so construed.
   
8. This Personal Directive is intended to be governed by the laws of the Province of .
   

Signature

Signed by me under hand and seal in the presence of my witness in the Province of , this ________ day of ________________, ________.

Record of Copies
Record of people and institutions to whom I have given a copy of this Personal Directive:

General comments regarding your Personal Directive

1. Read the entire document before you sign in the space provided. Make sure it says what you want it to say.
   
2. Do not leave any blank lines above your signature to be filled in after signing. Make sure there are no blank lines before you sign.
   
3. Each page should be numbered. (e.g. 1 of 3, 2 of 3, etc.)
   
4. You and your witness should initial all the pages.
   

Signing requirements for your Personal Directive

Please select a province (jurisdiction).

Limitations to the authority of your Agent

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