Medical treatment instructions - Professional Edge Lawyers

Power of attorney - Medical Treatment

If you are unable to make a medical treatment decision, your health practitioner will need the consent of your medical treatment decision maker before providing treatment to you. Your medical treatment decision maker must make the medical treatment decision they reasonably believe is the decision you would make if you had decision-making capacity.

Your details

Medical decision makers details

Your details

Name

Prefix

First

Middle

Last

Street address

Postal address, if different from street address.

Email address*

Contact number

Occupation

Date of birth

Preferred method of contact?*

Postal address

Phone

Medical decision makers details

It is helpful for you to talk to your medical treatment decision maker in advance about what is important to you and any preferences you have.

How many medical decision makers do you want to appoint?*

List in order from first to last.

First appointee

Name

First

Middle

Last

Address*

Date of birth*

Second appointee

Name

First

Middle

Last

Address*

Date of birth*

Third appointee

Name

First

Middle

Last

Address*

Date of birth*

Any limitations or conditions *

Please list any conditions or limitations

This field should be left blank