Student Life

Health Care Surrogate

Health Care Surrogate Form - $50

Fill out the form below to get started.

Health Care Surrogate
Is your son or daughter a legal resident of the State of Florida?
Will your son or daughter be the person signing this form?
Is your son or daughter 18 years old or older?

Please list the name of the person designated to act as the health care surrogate for your son/daughter.

Please list the name of the person designated as an alternate surrogate for your son/daughter in the event that the first health care surrogate is not willing, able or reasonably available to perform their duties.

Thanks for submitting!

Sorry you must be 18 or older to sign these forms
Sorry at this time we only offer this service to residents or Florida