You have the right to give instructions about your own health care. You also have
the right to name someone else to make health care decisions for you. This form lets
you do either or both of these things. It also lets you express your wishes regarding
donation of organs and the designation of your primary physician. If you use this
form, you may complete or modify all or any part of it.
For students 17 years of age and younger, a parent or guardian must complete the form
(below) before the student can be seen at Student Health Services.