Connecticut Durable Medical Power of Attorney Form

The Connecticut Power Of Attorney For Health Care Decisions form legally permits an appointed person who is often referred to as an `Agent, to make medical welfare decisions regarding a patient should they become incapacitated and unable to do so themself. The form requires two witnesses’ signatures,  in accordance with § 19a-575a, § 19a-575.

How to Write

Power Of Attorney

Enter details regarding power of attorney and alternative power of attorneys.

  • Principals name.
  • Names of power of attorneys.


Witnesses And Notary

Enter details of principal, witnesses and notary.

  • Date.
  • Principal`s signature.
  • Witnesses signatures.
  • Witnesses addresses.
  • County.
  • Town.
  • Date.
  • Name of principal.
  • Name of notary.
  • Date of expiration of notary.