Terminal Illness Planning Checklist Form
Use this checklist to organize important non-medical preparations related to terminal illness. This form does not collect sensitive medical or financial information.
Your Full Name
*
First Name
Last Name
Preferred Contact Method
Email
Phone
Mail
Designated Primary Contact (Name & Relationship)
Planning Checklist – Select all items you have prepared or wish to discuss
Personal letters or messages to loved ones
Instructions for digital accounts and passwords
Preferred end-of-life arrangements (e.g., memorial, burial, cremation)
Distribution of personal belongings
Care for pets or dependents
Other (please specify below)
If you selected 'Other', please specify
Is there someone you would like to notify about your plans?
Yes
No
Notification Contact Details (Name & Contact Info)
Special Wishes or Additional Notes
Submit Checklist
Should be Empty: