SimpleWill

Selected Plan: Medical Power Of Attorney

Welcome to Simple Will

You’re just a few steps away from completing your online plan. Please start by entering your contact information below. Once you begin, the process will guide you through each section — from personal details to beneficiaries — and should take about 15 minutes to complete. Take your time and know that you can save your progress and return at any point.

First Name *

Middle Name

Last Name *

Email *

Password *

Cell *

Your Contact Details
Please submit all answers with the proper capitalization and do not abbreviate any addresses or states. Your full legal name is required for your estate planning documents. This would be the name you are referred to on your driver’s license, social security card, passport or other federal government ID. Do not forget to add your full middle name if you have one. If your driver’s license, social security card, passport, or other forms of identification do not match, use the full name indicated on your driver’s license and list the other names in the “also known as” field.

Name:

Date Of Birth *

Are you married? *

Yes No

Suffix(optional)

✓

III

✓

Other

Gender

Male Female

Your Address

Full Address: *

State

County

Your Spouse Information
Please use your legal name as it appears on your license or government-issue ID

Your Spouse's Details

First Name: *

Middle Name

Last Name: *

Email *

Date Of Birth *

Phone Number *

Suffix(optional)

✓

III

✓

Other

Gender

Male Female

Full Address: *

State:

Zip Code:

Medical Power of Attorney
The Medical Power of attorney allows the person you name as your agent to make medically related decisions for you while you are alive. These powers become effective in the event of your incapacity. It is recommended that you name one primary (typically spouse/partner if married) and at least one successor.

Please name who you would like to serve as your Medical Power of Attorney.

Primary Agent : Full Legal Name: *

Phone Number:

Street Address: *

County

Successor Agent : Click the "+" button to add another agent

Phone Number:

Street Address:

County:

Important Signing Instructions

Important Signing Instructions

GENERAL INSTRUCTIONS

You must sign in front of two witnesses and a notary. ALL need to be present to sign at the same time.

You will date and sign your Will on page 2. The witnesses will print their names in two places, sign their names above the word WITNESS and print their addresses across from signature on page 3.

Medical Power of Attorney

You and the notary will sign and date on page 4.

Submission Screen

If you’d like to review your responses, you can navigate to any screen to check your answers, or simply use the "Previous" button to go back through the questionnaire. Click the “Submit” button below to be directed to the payment page for your selected plan. Once payment is complete, your information will be securely sent to our office for processing.

Your Progress