Health Care Proxy Form - Westchester Medical Center: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your name at the top of the form, clearly indicating who is appointing the health care agent.
Next, provide the name, address, and phone number of your chosen health care agent. Ensure this person is willing to take on this responsibility.
If desired, appoint an alternate agent by filling in their details in the designated section. This ensures continuity in decision-making if your primary agent is unavailable.
Specify any limitations or instructions for your agent regarding health care decisions. This can include preferences about life-sustaining treatments or organ donation.
Print and sign your name at the bottom of the form, along with the date and your address to validate your proxy appointment.
Finally, ensure that two witnesses sign the document, confirming they are not related to you or acting as your agent.

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