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Health Care Surrogate


If you were unable to make decisions for yourself — maybe because of illness or injury — you can name a health care surrogate to make healthcare decisions for you.

Different states have different laws around advance directives. The health care surrogate form below is legal in the state of Florida.

Before you get started, you may want to check out our Advance Directive Cheat Sheet to learn about legal and medical terms you'll need to know.

View the Health Care Surrogate form: English | Spanish | Creole

Where to Send It

Give a copy to your doctor and send us one too. You can fax it to 1-877-234-9988.

Or mail it to:
Devoted Health, Inc.
PO Box 540279
Waltham, MA  02454