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Obtaining POLST Forms:


Requirements before obtaining the newly adopted National POLST form with Virginia-specific info on page 2:  


  • Physician offices please contact us to obtain three guidance documents

  • Hospital facilities should have at least two trained facilitators, hospital providers should have attended PCP training, and floor staff should attend a brief 20 minute introduction to POLST.

All other facilities, please contact us for questions regarding your care setting.

Virginia recently adopted (2022-2023) the National POLST form.  This form is available in a fillable .pdf version free of charge (after meeting the above requirements).  See sample National POLST form.  Please contact us for details.

The Virginia POST form was last revised in 2017.  It is available for purchase (after meeting the above requirements) in the Members section.  See revised sample form.  This document provides a summary of the changes.

The copyright date at the bottom of the form is used to distinguish the different versions of POST.  Any Virginia POST form currently in use by a patient is still valid.


POST Forms are distributed by the Virginia POLST Collaborative through the Virginia POLST Administrative Home, Capital Caring. Each packet contains 50 POST forms.  Charges cover the expense of paper, printing and postage.

Packets:                                       Price:

1 - 4   (50 - 200 forms)                 $9.50 per packet, plus shipping

5 - 10 (250 - 500 forms)               $8.25 per packet, plus shipping

Shipping is a flat rate of $23.50 per order

Please use our Contact Us page to request larger orders as the shipping price will increase.


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