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WDHB would like your feedback about the Asian Advance Care Plan Leaflet and Form

Invitation to Asian community members and health professionals

WDHB would like your feedback about the Advance Care Plan Leaflet and Form

The National Advance Care Planning Cooperative team and Waitemata District Health Board ACP clinical coordinator is seeking feedback from Asian communities and health professionals about the attached Advance Care Plan leaflet and form currently available in English.

1.      The Advance Care Plan Leaflet (tri-fold brochure format)

This leaflet provides information about Advance Care Planning by promoting awareness about what to plan ahead for future health care including personal care,  treatment preferences for end of life situations, what can be done and who to talk to.

2.      The Advance Care Plan Form (4 pages)

This form is for individuals to document their personal care and specific treatment preferences for end of life situations. Additionally, it is about the existence of a will, and the location of important papers and other practical matters.

<<Advance care planning Leaflet>> <<My advance care plan form>>

Due to the sensitive nature of the subject matter, the Advance Care Plan Cooperative team would like your views on: the appropriateness of the design/graphics; the colour; the wording used on the leaflet and the form and; whether if there is a need for improvements. In addition, we are trying to find out if there is a need for the form and the leaflet to be translated into different Asian languages.

How to provide feedback:

1.      You can complete the online feedback form by clicking on this link



2.      You can complete the attached feedback form and email back to

        Stella Song: by email stella.song@waitematadhb.govt.nz

<<2013-5-17 SM ACP Feedback Form>>


3.      If you know of others who may be interested to provide feedback, please feel free to send this request for feedback and the form to your networks.


4.      If you wish to run a focus group with others to collect feedback using the attached form, we would be most appreciative, please send us the completed form(s) by post:

        Attn: Stella Song – Asian Health Support Services, Waiteamata DHB, Private Bag 93503, Takapuna

Deadline for feedback is Friday, 10 June 2013

If you would like to know more about ACP please go to www.advancecareplanning.org.nz. Your assistance, feedback and comments would be very much appreciated and valued by the ACP team.


Asian Health Support Services I Waitemata DHB

p: 09 4423239  I m:  021 2402230  I   f:   09 4868307