Health Care Proxy Form

About this template

A health care proxy form is an official document that designates a third party to be responsible for a person’s health when that person can no longer make decisions for themselves — be it temporary or permanent. Build a professional, HIPAA-friendly Health Care Proxy Form that works for your needs with Jotform Sign. Create, customize, and send in just a few clicks.

Ensure that your Health Care Proxy Form meets all your specific needs by personalizing it with our easy-to-use form builder. Drag and drop to upload certificates and images, create an automated signing order, make cosmetic changes to colors and fonts, and more. Once you’re finished designing, simply send and wait for confirmation e-signatures. Then all parties involved will receive a copy for their records.

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These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.