Welcome to the Blue Line Law Firm Health Care POA Questionnaire! Please use your legal name as it appears on your license or government-issue ID
Contact You Our office would like to discuss an Estate Plan option specifically for your needs. One of our qualified attorneys will be happy to assist in determining a plan just for you. We will contact you as soon as possible with the information you have provided.
Your Contact Details Your Contact Details
Your Spouse Information Please use your legal name as it appears on your license or government-issue ID
Health Care POA Your Health Care Agent will make medical decisions for you if you are incapacitated and unable to do so yourself. When picking a Health Care Agent, pick someone who would be comfortable serving in this role. Also, consider whether that person would have similar ideas as to you regarding medical care. If your doctors ever need to say that there is nothing further they can do except to keep you “hooked up” to machines, and you would not want that, don’t pick someone who would feel the opposite or too burdened to have to make those kind of decisions. If you choose to have your Health Care Agent serve jointly, your Health Care Agents will have to make decisions together by majority decision. In choosing whether your Health Care Agents should serve jointly, you should consider whether your Health Care Agents would be able to get along and make decisions together. If you select that you would like your Health Care Agents to serve jointly, you will want to select the “serve jointly” button next to each Health Care Agent who you wish to have serve jointly. If you wish to have only two Health Care Agents serve jointly and another Health Care Agent serve individually, please only select the box next to the two joint Health Care Agents and leave the box unselected next to the Health Care Agent you wish to serve individually.
Health Care POA - Spouse/Partner Your Health Care Agent will make medical decisions for you if you are incapacitated and unable to do so yourself. When picking a Health Care Agent, pick someone who would be comfortable serving in this role. Also, consider whether that person would have similar ideas as to you regarding medical care. If your doctors ever need to say that there is nothing further they can do except to keep you “hooked up” to machines, and you would not want that, don’t pick someone who would feel the opposite or too burdened to have to make those kind of decisions. If you choose to have your Health Care Agent serve jointly, your Health Care Agents will have to make decisions together by majority decision. In choosing whether your Health Care Agents should serve jointly, you should consider whether your Health Care Agents would be able to get along and make decisions together. If you select that you would like your Health Care Agents to serve jointly, you will want to select the “serve jointly” button next to each Health Care Agent who you wish to have serve jointly. If you wish to have only two Health Care Agents serve jointly and another Health Care Agent serve individually, please only select the box next to the two joint Health Care Agents and leave the box unselected next to the Health Care Agent you wish to serve individually.
Signing Your Documents Some state laws require that certain parts of your health care documents be notarized and witnessed by two disinterested individuals. This means that the notary and two witnesses must not be an agent or beneficiary in your documents. If the documents are not signed properly, there is a risk that they will not be legally valid documents. To best assist you in making sure your documents are signed properly, we have designed two options that you can choose from to have your documents executed: You may choose to come to our office location where our team will have all your documents printed and ready for your signatures. We provide the notary and two witnesses. All you have to do is schedule a time and come visit! You may also choose to sign your estate planning documents virtually/remotely. If your state allows it, we will coordinate with you a date with our online notary to execute your documents right from your residence. You will need a computer with a camera and microphone for this option. Generally this is a $75 charge for this option additionally. This will still create a legally binding document. In order to use this option, you may be required to have 2 witnesses with you who are not named in the will. The last option is the cost of drafting valid estate planning documents. You will be able to confirm that the questionnaire was correctly completed and our office will confirm your choices with you. After a legal review of your documents and payment, we will then send you the documents to be able to be printed and executed by you.
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