POWERS OF ATTORNEY QUESTIONNAIRE

ENDURING POWER OF ATTORNEY You can choose more than one attorney if desired. Please list below who you are appointing as your attorney/s?

Attorney (1)

Attorney (2)

In the event your appointed attorney/s cannot or is not willing to act as attorney/s, please list below who you would like to appoint as an alternative attorney/s

“Alternative” Attorney (1)

“Alternative” Attorney (2)

MEDICAL TREATMENT DECISION MAKER

You can nominate more than one Medical Treatment Decision Maker. However, please note that only one person can act as decision maker at any one time. Accordingly, the first person listed as your Medical Treatment Decision Maker, will be the first point of contact if a medical decision is required and you lack capacity.

Medical treatment decision maker (1)

Medical treatment decision maker (2)

Please do not hesitate to contact our office on 9670 7440 if you require assistance completing this Questionnaire.