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.

Related templates

Medical Records Release Authorization

Build a medical records release authorization form in seconds. Works on any device. Android and iOS compatible. Converts to a PDF. No coding knowledge required.

Rent Ledger Template

Create a rent ledger agreement in seconds. Fill out and e-sign from any smartphone, tablet, or desktop. Easy to customize and share. Converts to a PDF.

General Release of Liability Form

Create a liability form for any and all of your needs. Works on all desktop, tablet, and mobile devices. Drag and drop to customize. Collect e-signatures.

Free Non-Compete Agreement Template

Create a free non-compete agreement with Jotform Sign. Easy to customize and share. Converts to a PDF document. Fill out and e-sign on any device.

Summer Camp Parental Consent

Create a summer camp consent form for parents of your campers. Intuitive form building. No coding required. Drag and drop to design. iOS and Android compatible.

Hospital Discharge Template

The Hospital Discharge Template is a detailed document that provides patients with instructions and information upon discharge from a healthcare facility

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.