Order, Medical Treatment Decision Maker, Kallan Lawyers

Who is this for?

One person or a couple (mirror MTDMs in one order).

Just me Me and my partner (mirror MTDMs)

Person 1 — you

Full legal name *

Date of birth *

Phone

Address *

Email *

Decision makers

Up to three people in priority order. The first listed acts first; the next only steps in if the previous can't.

If couple. The form captures decision makers once and applies them to both MTDMs. Most spouses appoint each other primary and a shared alternate (typically an adult child). Use "Person 2 differs" below if Person 2 wants different decision makers.

Primary decision maker

Full legal name *

Relationship to you

Date of birth Optional

Phone *

Address *

Email Optional

Second decision maker steps in if primary can't act

Full legal name Optional

Relationship

Date of birth Optional

Phone

Address

Email Optional

Third decision maker optional · further fallback

Full legal name Optional

Relationship

Date of birth Optional

Phone

Address

Email Optional

Your medical wishes

Optional but useful — guides your decision maker if a tough call has to be made.

Specific medical wishes Optional

Resuscitation and life-prolonging treatment

Standard medical care — leave to my decision maker Limit life-prolonging treatment where recovery is unlikely Discuss at our meeting

A more detailed Advance Care Directive (next section) lets you record specific instructions or refusals.

Advance Care Directive Now available

An optional companion document that records your specific medical directions and values. Works hand-in-hand with the MTDM appointment.

Why add an Advance Care Directive?

Under the Medical Treatment Planning and Decisions Act 2016, an Advance Care Directive lets you record either instructions that doctors must follow (e.g. refusing specific treatments) or your values that guide your decision maker. Particularly important if you have strong religious, cultural, or personal preferences about end-of-life care, blood products, organ donation, or specific treatments.

Yes — include an Advance Care Directive with my MTDM order. Adds a small fee, confirmed in writing before drafting.

Supporting documents

Optional uploads.

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Drop files here, or click to browse

Up to 10 files · 10 MB each · PDF, DOC, DOCX, JPG, PNG accepted

Useful: any existing MTDM you'd like reviewed or revoked, medical records you'd like considered, religious guidance documents.

Special requests, anything outside standard scope?

Existing MTDM to revoke, complex family circumstances, specific religious or cultural considerations.

Your details

Who we send the documents and invoice to.

Your name *

Firm or business Optional

Email *

Phone Optional

Acknowledgments

Before you submit, please confirm each of the following.

Capacity and voluntariness. I have decision-making capacity at the time of submitting this order, I am acting voluntarily, and no one is pressuring me. Witnessing arrangements. I understand the MTDM appointment must be witnessed by two adult witnesses (one of whom must be a registered medical practitioner or an authorised witness). Kallan Lawyers will arrange this with me when the document is ready to sign. Informing the decision maker. I will inform the people I'm appointing that I'm doing so. They should accept the role before the document is signed. Limitation of liability. Total aggregate liability is limited to the fee paid for this pack. Consequential and indirect losses are excluded to the maximum extent permitted by law.

0 of 4 confirmed

Medical Treatment Decision Maker.

Who is this for?

Person 1 — you

Person 2 — your partner

Decision makers

Your medical wishes

Resuscitation and life-prolonging treatment

Advance Care Directive Now available

Why add an Advance Care Directive?

Person 2 — anything different?

Supporting documents

Special requests, anything outside standard scope?

Your details

Acknowledgments

Order received.

What happens next