Durable Power of Attorney Form

June 29, 2010 | By | Reply More

A durable power of attorney form enables you to appoint an attorney who will make medical, financial and healthcare decisions on your behalf in the future should you be unable to make the said decisions for yourself for any reason.  This form becomes active when you are incapacitated and therefore unable to make sound medical, financial and healthcare decisions for yourself.  Below is a sample durable power of attorney form.

Sample Durable Power of Attorney Form


I ______________ (first name) _________________ (second name) ______________ (surname) being of sound mind and without any coercion do hereby willingly give my consent and permission to ________________________ (agent/ attorney) to make medical, financial and healthcare decisions on my behalf should I be incapacitated and therefore unable to make these decisions myself.  I hereby acknowledge that I fully understand the authority given to _______________________ (agent/ attorney) to make medical, financial and healthcare decisions on my behalf.  I hereby state that this consent shall become active in the event that I am incapacitated and unable to make sound decisions.

Signature: ___________________________ Date: _________________________

Category: Power of Attorney forms

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