POLST Form

POLST Form

Member: $0.00
Nonmember: $1.10Your price

See Quantity Discount

The Portable Orders for Life-Sustaining Treatment (POLST) form represents a way of summarizing wishes of an individual regarding life-sustaining treatment. The form is intended for any individual with an advanced life-limiting illness.

POLST form pricing update

We have updated our pricing for POLST forms to better reflect production and distribution costs. WSMA members may receive up to 100 free copies per quarter.

Nonmember order pricing:

Quantity    Price per form
 1-5   $1.10
 6-10    $0.85
 11-99    $0.50
 100-250   $0.40 
 251+   $0.35