Health Care Proxy Forms

On this page you will find PDF files of New York Health Care Proxy Forms. These forms are also known as advance health care directives. These forms enable you to appoint a trusted family member or friend to make health care decisions for you if you lose the ability to make decisions yourself. These forms are free and provided as a service to all New Yorkers. Be sure to include current phone numbers for your health care agent and alternate so they can be contacted in an emergency.

New York Health Care Proxy Forms (provided by the NYS Department of Health). 

English (PDF)
English (Fillable PDF)
Chinese (PDF)
French (PDF)
Haitian Creole (PDF)
Italian (PDF)
Korean (PDF)
Russian (PDF)
Spanish (PDF)

Visit the New York State Department of Health Web site for information on patient rights and advance care planning resources.