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Health Care Proxy Form - Westchester Medical Center 2026
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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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Related links
Unless you have made your wishes clear in a living will or through an appointed health care proxy, there is no guarantee that your wishes will be followed.Read more
A healthcare proxy or similar instrument executed in another state or jurisdiction in accordance with its laws will be considered validly executed as a New