Powers of Attorney Instruction/Information Form.
In a power of attorney you give someone else power to make legal decisions on your behalf while you are alive. There are two types of power of attorney in Ontario.
The following is an information sheet that you can print (use the print button on your browzer) and fill out in preparation for your meeting with us. If you need advce about completing any part of the form, hold off filling it in until your meeting with us.
POWER OF ATTORNEY FOR PROPERTY
Name _________________________________________________________
Address: _______________________________________________________
Name _________________________________________________________
Address: _______________________________________________________
Joint or Joint and Several _________
Restrictions ___________________________________________________
_________________________________________________________________
Compensation ____
Effective On: Execution ____
Specific Date ____/_____/_____
Specific Contingency _____________________________
Substitute Attorney(s)
Name _________________________________________________________
Address: _______________________________________________________
Name _________________________________________________________
Address: _______________________________________________________
Joint or Joint and Several _________
POWER OF ATTORNEY FOR PERSONAL CARE
Name _________________________________________________________
Address: _______________________________________________________
Name _________________________________________________________
Address: _______________________________________________________
Joint or Joint and Several _________
Restrictions? ___________________________________________________
Specific Instructions _____________________________________________
________________________________________________________________
Consent to Treatment? _____
Name of Family Physician ______________________________________
Preferred Assessors:
Family physician and/or such other physician as he/she may designate? _____
Other __________________________________
Substitute Attorney(s)
Name _________________________________________________________
Address: _______________________________________________________
Name _________________________________________________________
Address: _______________________________________________________
Joint or Joint and Several _________