Power of Attorney Questionnaire

1. Power of Attorney Type Selection

A Power of Attorney is a legal document that allows someone else to make decisions on your behalf. Please select the type(s) of Power of Attorney you're interested in.

Health and Welfare

Allows your attorney to make decisions about your healthcare and daily routine if you lose mental capacity.

What does this cover?

Health and Welfare Power of Attorney covers:

  • Decisions about medical treatment
  • Daily routine (washing, dressing, eating)
  • Moving into a care home
  • Life-sustaining treatment decisions
  • Social activities and contacts

This type of POA can only be used if you've lost mental capacity to make these decisions yourself.

Property and Financial Affairs

Allows your attorney to manage your property and finances, either now or if you lose mental capacity.

What does this cover?

Property and Financial Affairs Power of Attorney covers:

  • Paying bills and managing bank accounts
  • Collecting benefits or pensions
  • Selling or renting your property
  • Making investments
  • Buying or selling possessions

This type of POA can be used immediately or only when you lose capacity, depending on your preference.

2. Personal Details

3. Attorney Details

Your attorney(s) are the people you choose to make decisions on your behalf. You can appoint more than one attorney and decide if they should act jointly or separately.

Jointly (must all agree)
Separately (can act independently)
Jointly and Separately

4. Replacement Attorneys

You can appoint replacement attorneys who will step in if your original attorneys are unable or unwilling to act.

Yes
No

5. Property and Financial Affairs Preferences

Please provide details about your property and financial situation and any specific instructions for your attorney.

Immediately
Only if I lose mental capacity
Yes
No

6. Health and Welfare Preferences

Please provide details about your healthcare preferences and any specific instructions for your attorney.

I give permission to refuse life-sustaining treatment
I do not give permission to refuse life-sustaining treatment

7. Additional Information

Important: A Power of Attorney must be registered with the Office of the Public Guardian before it can be used. We will guide you through this process.