Important Information About Your Health Care Proxy

The Health Care Proxy form is available in both English and Spanish.

This is an important legal form. For questions about health proxies, call 914-734-3611.

Before signing this form, you should understand the following facts available in Adobe Acrobat format:

A printable version in English can be accessed by clicking here.
A printable version in Spanish can be accessed by clicking here.

In addition, the hospital is offering a wallet-size form by calling the hospital's physician referral line at 1-800-482-HVHC. The wallet size card does not replace the full form but serves as a tool in alerting medical professionals should a person be unable to communicate their wishes. For specific questions about filling out the form, please call the hospital's Quality Management Department at 914-734-3611.