Wyoming Medical Power of Attorney Form

The Wyoming medical power of attorney form is a legal document in which a Principal has the ability to delegate health care powers to an Attorney In Fact/Agent with whom they feel comfortable, to make their health care decisions, on their behalf, when they are no longer able to make decisions on their own. This document provides full powers to the selected Agent unless the Principal decides at a later date, to revoke the powers previously authorized. This document must be signed in the service of a licensed notary or two witnesses.

How to Write

Step 1 – Download the Document –

  • At the top left side of the document, enter the county in which the document shall be executed

Step 2 – The Parties –

  • Submit the Principal’s name
  • Address
  • City
  • AND
  • Enter the name of the appointed Agent

Authorize permission to make health care decisions by:

  • Entering the Agent’s name
  • Submit the Principal’s name
  • Agent and Principal must carefully review the outline of the document

Step 3 – Signature – To be provided in the presence of a notary

  • Submit the date of commencement of the document in dd/m/yy format
  • Date the Principal’s signature in dd/m/yy format
  • Principal’s signature
  • Principal’s printed name

Step 4 – Notarization –

  • Once the notary has witnessed the Principal’s signature, the notary shall complete the document by providing the remaining requirements
  • Notary shall affix the official seal