Personal Care Power of Attorney Questionnaire
Name
Attorney(s)
Jointly & Not Severally Jointly & Severally
Alternate Attorney(s)
Clause directing no life support
yes no
Specific Directions
NOTES:
Partially complete this form with the balance to be finalized at your consultation with the lawyer.
Attorneys for personal care: The attorney may not be the following people: your landlord, social worker, counsellor, teacher, advocate, doctor, nurse, therapist or other health care provider, homemaker or attendant, or any person who provides care for you in the place where you live.
Jointly and not separately means all need to sign. Jointly and severally means either can sign.
Life Support: is like a living will clause which directs that life support system not be used if there is no expectation of recovery.
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[ Welcome Page | About L. S. Pascoe | Service Principles | Articles | Legal Information Packets | Fees | Forms | Resources | Client Pages | Survey Contest | Index & Update Information | News & Views| Legal Quiz | Reviews! | Guestbook | Contact Information]
Copyright ©1995-2005 Lawrence S. Pascoe & GIB. All Rights Reserved. Re-use, retransmission or alteration of any text or images from this sitewithout expressed written permission is strictly prohibited.
