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Texas Medical Power of Attorney

Your power of attorney will be prepared based on the information you provide in this questionnaire.  Please fill out every section of the document as carefully as possible. After you have completed the questionnaire, click on the "send" button at the top of the form.  

Note that on April 20, 2020, Governor Abbott issued an order temporarily authorizing notaries to notarize powers of attorney by video conference. You can read about the order by clicking on the following link: Order. This will help you answer the final question.

If you have questions about completing this questionnaire, please don't hesitate to call me at (832) 545-3955 or email me at rania@texaswillsandtrustslaw.com. 

All my best,

Rania S. Combs
Attorney At Law

Using this questionnaire to obtain a free medical power of attorney is not legal advice and does not create an attorney-client relationship between you and Rania Combs or Rania Combs Law PLLC. An attorney-client relationship is established only after an attorney at Rania Combs Law PLLC has expressly communicated the ability to represent you and entered into a signed written engagement agreement that outlines the scope of the legal services to be performed.

Contact Information

Enter the following contact information.
Enter phone number, including area code, in the following format: (xxx) xxx-xxxx.

Who would you like to designate as your agent?

Enter your agent's full legal name.
Enter phone number, including area code, in the following format: (xxx) xxx-xxxx.

Who would you like to designate as your first alternate agent?

Enter your first alternate agent's full legal name.
Enter phone number, including area code, in the following format: (xxx) xxx-xxxx.

Who would you like to designate as your second alternate agent

Enter your second alternate agent's full legal name.
Enter phone number, including area code, in the following format: (xxx) xxx-xxxx.

Will you use an online notary to sign your power of attorney in accordance with Governor Abbott's Order Issued on April 8, 2020?


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