Home Join Now Learn More Sign in
Home | Admin | Sign Out 
Find a Form 

Access thousands of free legal and business forms contributed by leading lawyers and other professionals

Search by key words (e.g., "Sales Contract")
Advanced search

 
Promote Your Business  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Promote Your Business 
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Promote your business  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
Add your free profile  
  • Contribute a legal or business form and network with thousands of potential clients, businesses, and professionals

    Upload a Form Add Your Executive Profile
 
Connect

Terms Of Use

Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
Close

Thank you for using
Yourfreelegalforms.com


Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile displayed on the same page as the form for free, powerfull, targeted marketing to those searching for legal forms and advice.

Advertise your business to thousands for free – Contribute a form
Form #710

Designation of Health Care Surrogate

Average user rating:  
Not Yet Rated
Rate it

Florida - Designation of Health Care Surrogate (free form to use)

Need this form customized? Download This Form Printer Friendly Version

Florida.

DESIGNATION OF HEALTH CARE SURROGATE

Name: _________(Last) _________(First) _________(Middle Initial)

In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for health care decisions:

Name: ...................................................................................................................................................................................................

Address: ..............................................................................................................................................................................................

Zip Code: _________

Phone: _________

If my surrogate is unwilling or unable to perform his duties, I wish to designate as my alternate surrogate:

Name: ...................................................................................................................................................................................................

Address: ..............................................................................................................................................................................................

Zip Code: _________

Phone: _________

I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility.

Additional instructions (optional): _________

I further affirm that this designation is not being made as a condition of treatment or admission to a health care facility. I will notify and send a copy of this document to the following persons other than my surrogate, so they may know who my surrogate is.

Name: ...................................................................................................................................................................................................

Name: ...................................................................................................................................................................................................

Signed: .................................................................................................................................................................................................

Date: .....................................................................................................................................................................................................

Witnesses:

1. ...........................................................................................................................................................................................................

2. ...........................................................................................................................................................................................................



 
Contributed by
Legal Concepts LTD
 
Name of Firm Legal Concepts LTD
Total Forms Contributed 63
 

See All Legal Concepts LTD's Forms
 

Related Forms

Appointment of Health Care Representative - Indiana
Child's Medical Care Authorization
Landmark Designation Agreement
Surrogate Release and Hold Harmless Agreement
Alternative Designation of Beneficiaries

Terms Of Use

Submissions to this site, including any legal or business forms, posts, responses to questions or other communications by contributors are not intended as and should not be construed as legal advice. You are strongly encouraged to consult competent legal council before engaging in any action based upon content contained on this site.

These downloadable forms are only for personal use. Retransmission, redistribution, or any other commercial use is prohibited. This includes reposting forms from this site to another site offering free legal or other document forms for download.

Please note that the donator may have included different usage terms regarding this form, and you agree to abide by these terms. It is highly recommended that you have a licensed attorney review any legal documents for which you are searching in order to make sure that your needs are being properly and completely satisfied.

Your use of this site constitutes your acceptance of our terms of use and your agreement to hold this site, its officers, employees and any contributors to this site harmless for any damage you might incur from your use of any submissions contained on this site. If you do not agree to the above terms, please do not proceed.

These forms are provided to assist business owners and others in understanding important points to consider in different transactions. They are offered with the understanding that no legal advice, accounting, or other professional service is being offered by these documents or on this website. Laws vary in the different states. Agreements acceptable in one state may not be enforced the same way under the laws of another state. Also, agreements should relate specifically to the particular facts of each situation. Therefore, it is important to consult legal counsel whenever utilizing these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com is not engaged in recommending or referring members on the site or making claims about the competence, character or qualifications of its participating members.
Close

Thank you for using
Yourfreelegalforms.com


Your online source for 100% free legal and business forms.
Have a form to contribute?
Contribute a legal or business form, checklist or article and have your profile displayed on the same page as the form for free, powerfull, targeted marketing to those searching for legal forms and advice.



Was this form helpful? Yes No
Need a different form? Yes No


Need a different form? Need a custom form or service?

post a request to our community.


Comments




Keywords: Florida, Health Care Surrogate, will, wills, legal forms

close