Skip to main content

Probate and Family Court forms for health care proxy

A collection of court forms related to health care proxies.

A health care proxy is a legal document signed by one person. It gives another person authority to make decisions related to their healthcare if the person signing is no longer able to make their own decisions.

These forms may not display properly in your browser. Please download the form(s) you need and open in Acrobat Reader. For more information, please see What to do if you can't open court PDFs.

Skip table of contents

Table of Contents

You skipped the table of contents section.
Open PDF file, 143.1 KB,  Procedure for Actions filed under G.L. C. 201D (English, PDF 143.1 KB)

(7/1/14). Provides detailed information on when you can file a petition under GL c.201D, necessary forms, and how to file them in Probate and Family Court.

Open PDF file, 969.83 KB,  Petition for Special Proceeding in re: a Health Care Proxy (MPC 405) (English, PDF 969.83 KB)

For use in Probate and Family Court pursuant to G.L. c. 201D (7/1/14). This form may not display properly in your browser. Please download the form and open it using Acrobat reader.

Open PDF file, 1.41 MB,  Statement of Attending Physician filed with Petition for Special Proceeding in re: a Health Care Proxy (MPC 406) (English, PDF 1.41 MB)

(7/1/14) Used by the Probate and Family Court in a special proceeding regarding a Health Care Proxy. This Statement must be dated, and an examination must have taken place within 30 days prior to filing. This form may not display in your browser. Please download the form and open it using Acrobat reader.

Decree on Special Proceeding re: a Health Care Proxy (MPC 793) 

For use in Probate and Family Court proceedings related to health care proxies. Revised 7/1/14. This form is also available in Portuguese and Spanish. Click the link above to access the translations.

Contact

Online

Probate and Family Court locations 

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback