Download Free Vermont Medical Power of Attorney Form
Use this form if you would like to elect a representative for medical decisions in the chance that you cannot mentally think with a clear mind on your behalf. The agent you select will decide in the best interests of your health.
The following is required only if this document is being signed while the principal is in or being admitted to a hospital, nursing home or residential care home. Statement of ombudsman, hospital representative, recognized member of the Vermont clergy, Vermontlicensed attorney or other person designated by the county Probate Court: I declare that I have personally explained the nature and effect of this durable power of attorney to the principal and that the principal understands the same.