This document is designed to be printed AFTER you enter your personal information.

 

1.  Type in the answers required in the boxes.

2.  Put your name on the first line.

3.  Use the tab button to move to the next blank space

4.  When it asks for you to appoint three agents, you need to enter one Primary agent and two alternate agents. You MUST include their relationship to you.

5.  After you have printed it out, sign it IN THE PRESENCE OF TWO WITNESSES OR ONE NOTARY PUBLIC.

6.  Give a copy to your treating physician immediately.

7.  Keep the original with your other legal documents.

 

This is a legal document that has been pre-approved by the Ohio State bar Association and it should not be changed without legal consultation. If you want or need it to be different in any manner, you should seek legal consultation.