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

Interview Consent Agreement

Gather interview consent forms online. Can be filled out and signed on any device. Converts to a PDF instantly. Easy drag-and-drop customization.

NonProfit Donation Consent Template

Create a nonprofit donation consent form in seconds. Drag-and-drop to design and customize. Collect signatures from any smartphone, tablet, or desktop.

Summer Camp Permission Slip

Create summer camp permission slips for parents of your campers. Intuitive form building. Drag and drop to design. Works on desktop, tablet, and mobile devices.

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.

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.

Release of Liability Form

Create a release of liability form to ensure your company is covered in case of an accident. Signable on any type of device — desktop, tablet, and mobile friendly.

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.