Health Care Power of Attorney Worksheet
A Health Care Power of Attorney is a written declaration of your wishes regarding who you would like to make medical decisions on your behalf in the event that you are temporarily incapacitated.

Please be aware, this form may take a significant amount of time to complete.
Any information that you provide in this questionnaire or at any meeting with one of our attorneys will remain confidential according to the law. We will not disclose any of the included information without your express written consent. Additionally, in order for Shinaver Law Office to provide you with the best possible legal services, it is important that your answers to each question are true and accurate.
Submitting this form does not create a lawyer-client relationship, but serves to allow Shinaver Law Office, LLC to provide you with the proper information needed to make an informed decision regarding your estate planning needs. A subsequent Compensation Agreement will need to be completed for further legal representation.

If you have any questions regarding this form, its contents, fees, executing the document, or any other concerns please contact our office.

By entering your email below, and clicking or tapping on the "Next" button, you agree to the above terms and conditions.

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