Healthcare Proxy

Please fill out and submit the form below to create an account with Wills R Us and start the project for your Healthcare Proxy Document.

$99.95.

The process can be done in a day.

Yes, once you complete the form, you will talk to an Attorney to review and finalize it.

Yes, you can always go back and make edits and changes for a small fee.

"*" indicates required fields

First Name*

Last Name*

Address*

City State

ALTERNATE HEALTHCARE AGENT INFORMATION

First Name of Healthcare Agent*

Last Name of Healthcare Agent*

Healthcare Agent Relationship to You*

HEALTHCARE AGENT INFORMATION

First Name of Alternate Healthcare Agent*

Last Name of Alternate Healthcare Agent*

Alternate Healthcare Agent Relationship to You*

Healthcare Proxy Document

Price:

Total

Payment Method*

Name

This field is for validation purposes and should be left unchanged.