Please complete this form to provide the attorney information about you and the individual you trust to make health care decisions for you if you are unable or do not want to make them yourself. These decisions should be based on your values and wishes.
The agent must be 18 years old, know you well and be comfortable talking with and questioning your physicians or health care providers. A parent can be an agent.
When your power of attorney is drafted, an attorney will email you to schedule a time to review the document with you via Zoom. After the Zoom call, you are responsible for mailing the power to our office to be executed.
The $175 payment is due before you pick up or authorize us to mail the original document to you. Credit card payments are accepted at “Submit a payment” on the firm’s home page at wochnerlawfirm.com