Massachusetts Medical Society: Please Note

Please Note

PLEASE NOTE: The agreement between the Massachusetts Medical Society and Massachusetts Health Decisions, the nonprofit publisher of the Health Care Proxy, allows individual patients to print one or two copies for their personal use only. People and organizations wishing to make multiple copies, or to use this form in their organization or agency, or to get translations in other languages, must first get written permission from Massachusetts Health Decisions.

Call 781.784.1966 or email:

A great deal of information about the Proxy for professionals and the public, in English and 15 other languages, is available at:

If you still wish to print a copy of the form, click here:

(.pdf, 4 pages)

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