Will Questionnaire

Power of Attorney Questionnaire

Health Care Directive Questionnaire

Advice Following
the Signature of Your Will

Health Care Directive (Living Will) Questionnaire

A Health Care Directive is a document executed by a competent individual concerning health care decisions to be made in the event that the individual becomes incompetent to make such decisions. There are three types of Health Care Directives. A general directive does not clearly anticipate and give direction relating to treatment for the specific circumstances that exist but is used for guidance as to the wishes of the person. A specific Health Care Directive clearly anticipates and gives directions relating to the treatment for the specific circumstances that exist. This type of Health Care Directive has the same effect as a health care decision made by a person with full capacity to make and communicate such a decision concerning a specific proposed treatment. Finally, you may appoint a proxy, a person who is given the power to make health care decisions for you.

TKB LAW will contact you after receiving this questionnaire to discuss your wishes and no drafting will be done until after that contact.

Your name -


- General Directive


- Specific Directive:

- Appoint a Proxy:

Name -
Relation -
City/Town -
Phone Number -

Health Care Information:

Name of Doctor -
Phone Number -

Completing this form does not constitute a valid Health Care Directive. The information will be used to complete a Health Care Directive for you which will become valid once properly executed.