The forms listed below are health care proxies, which are legal documents. They allow you to name someone (an agent) to make medical decisions for you if you are unable to make or communicate those decisions for yourself. Your agent will act for you only if you are incapacitated and he/she will follow your wishes and act in your best interest.

        You will need to complete both forms as one appoints your agent and the other lists your medical wishes. Instructions for all forms are below.

    Please forward a copy of the completed forms to our office and keep the original with your other important documents. You also need to make copies of the form for your agents and your doctor. Thank you.

• DURABLE POWER OF ATTORNEY FOR HEALTH CARE (all states)
• HEALTH CARE DIRECTIVE (all states)

 

 

• To complete the Durable Power of Attorney for Healthcare:

 
 1. Enter your name and your agent's name in the blank spaces on page 1. The  person named on this form will act as your primary agent.
 
 2. Sign the form with two adults as your witnesses.

 

• To complete the Healthcare Directive form:

 
 1. Enter your name at the top of the form.
 
 2. Check one of the options under Part C.
 
 3. You can enter a second person to act as an alternative agent under section  5 if you wish to. (OPTIONAL)
 
 4. Sign and date the directive with two adults as your witnesses.
 

 

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