Advance Healthcare Directive Living Will - Online Legal Forms & Documents Creator

Health Care Proxy

First choice for Health Care Proxy

Full Name:

Street Address:

City/Town:

State

Zip Code:

Phone:

Relationship:

e.g(brother, wife, friend, sister, etc.)

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Alternate Health Care Proxy

Alternative Agent's Information

Full Name:

Street Address:

City/Town:

State

Zip Code:

Phone:

Relationship:

e.g(brother, wife, friend, sister, etc.)

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Health Care Proxy Authority And Instructions

How much authority do you want your health care proxy to have?

Limited to following the directions listed in this document Must follow my listed directions but is also able to make decisions not covered in this document Complete authority to make decisions even if they contradict this document

I want your health care proxy to be able to:

Decide if I need tube feeding

Yes No

Have access to my medical records

Yes No

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Advance Healthcare Directive - Living Will

Health Care Proxy

First choice for Health Care Proxy

Alternate Health Care Proxy

Alternative Agent's Information

Health Care Proxy Authority And Instructions

How much authority do you want your health care proxy to have?

I want your health care proxy to be able to:

Decide if I need tube feeding

Have access to my medical records

Frequently Asked Questions