In Case of Emergency (I.C.E) Form

Our customized In Case of Emergency form is a FREE PDF download that combines your emergency contacts, medical and Health Care Planning information together into one document, allowing emergency responders and healthcare teams to see, at a glance, your medical history, medications, and preferences for care. It can be easily updated as your health, preferences and medications change.

Print and take this I.C.E. document with you in any emergency, and to all medical appointments and procedures.

It is up to you and those who will speak for you to make sure that vital documents are delivered at all points of care: to first responders and paramedics, emergency departments, hospitals, home care, assisted living and long term care.

Put copies of your Health Summary and your Advance Care Planning documents on or beside your fridge – or a clear note on your fridge where they can be easily found!

These are ‘living documents’, meant to be used in a time of crisis. They aren’t any good in a safe deposit box or lawyers office.



Do your Substitute Decision Makers/Representative know about these documents? Have you had courageous conversations with them about your values, beliefs, preferences for resuscitation and for future health care?

Learn more

  • Health Care Planning is for Now

  • Advance Care Planning is for Your Future

  • Who will Speak for You? Introduction

  • Who will Speak for You? Representation Agreements

  • Understanding Capability

  • Enduring Power of Attorney in Healthcare

Since 2010, Connie Jorsvik, founder, has been helping clients determine personal values, beliefs and preferences for future health care, and compiling their wishes into official documentation.

If you need assistance, please reach out.