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.

For specific questions about filling out the form, please call the hospital's Quality Management Department at 914-734-3611.