Health Care Proxy Information and Forms

The Health Care Proxy is a simple document, legally valid in Massachusetts, which allows you to name someone (an “agent”) to make health care decisions on your behalf if you are unable to make or communicate those decisions.

This Health Care Proxy document, provided free of charge, gives a clear explanation of the responsibilities of a health care agent, and simple directions on how fill out and sign the form. There are also instructions on how to revoke or cancel the document at a later date, if you choose to do so.     

• Massachusetts Health Care Proxy Information, Instructions and Form (.pdf, 4 pages) 
  Information, instructions, and form for naming someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.